Setting

This audit may be particularly relevant to liaison psychiatry services and other mental health services that accept referrals from emergency departments.

Background

The NHS Plan introduced an aim to reduce waiting times for patients attending emergency departments (Department of Health, 2000). This audit aimed to measure the proportion of patients referred to mental health services who remained in an emergency department for longer than 4 hours and to identify the reasons for prolonged attendance.

Standards

The standard was derived from the NHS Plan, which stipulated that, from 2004 onwards, over 98% of patients attending an emergency department should have completed their attendance episode within 4 hours (Department of Health, 2000). This time includes any assessment and management by specialist services that occurs in the emergency department. The standard set was that over 98% of referrals to liaison psychiatry should have an attendance time of under 4 hours.

Method

Data collection

Emergency department records were collected for all patients who were referred by the emergency department to the liaison psychiatry service over a 3-month period. For each attendance, the total attendance time was calculated. Where the attendance time was over 4 hours, the records were examined to identify the main reasons for a prolonged attendance.

Data analysis

Two time intervals were calculated, between:

ᐅ booking into the emergency department and assessment by a doctor

ᐅ referral to the liaison psychiatry service and psychiatric assessment.

For both intervals, an arbitrary duration of greater than 1 hour was recorded as contributing to a prolonged attendance.

Resources required

People

Cooperation is required from emergency department staff in order to collect patient records. It is suggested that the audit is undertaken by at least two people, owing to the amount information to be collected and the possible need to confer when points are uncertain. It is recommended that the auditors are clinical staff who are familiar with clinical records and emergency department care.

Time

The audit should be conducted over a long enough period to gain a representative number of cases (e.g. 3 months). It is estimated that data collection would take 15–20 hours.