Objectives To evaluate the impact of an expansion of liaison psychiatry services (LPS) on patient management, outcomes and treatment costs for emergency department (ED) attendances for self-harm.
Design Retrospective before and after cohort study using routinely collected Self-Harm Surveillance Register data.
Setting A large hospital in South West England.
Subjects Patients attending the ED for self-harm.
Interventions Extension of the LPS’ working hours from 9:00 to 17:00, Monday to Friday to 8:00 to 22:00, 7 days a week, following a £250 000 annual investment
Main outcome measures Number and characteristics of ED attendances for self-harm. The before and after cohorts were compared in terms of key process measures, including proportion of patients receiving a psychosocial assessment, average length of hospital stay, waiting times for assessment, proportion of patients who self-discharged without an assessment, levels of repeat self-harm attendances and mean cost per patient attendance.
Results 298 patients attended ED for self-harm on 373 occasions between January and March 2014, and 318 patients attended on 381 occasions between January and March 2015. The proportion of ED attendances where patients received a psychosocial assessment increased from 57% to 68% (p=0.003), median waiting time decreased by 3 hours and 14 min (p=0.017), and the proportion of episodes where patients self-discharged without a psychosocial assessment decreased from 20% to 13% (p=0.022). The mean cost per patient attendance was marginally lower after the intervention (−£84; 95% CI −£254 to £77).
Conclusions The extended LPS seems to have had a favourable effect on the management and outcomes of self-harm patients. The cost of extending the LPS’ working hours might be partially offset by more efficient assessment and discharge. The impact of the extended LPS on the care of hospitalised patients with mental health problems other than self-harm requires further evaluation.
- psychosocial assesement
- service evaluation
- liaison psychiatry
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Contributors BCO contributed to the writing and critical reviewing of the manuscript, development of methods, analysis of data, interpretation of results and consensus meetings. EM contributed to the writing and critical reviewing of the manuscript, acquisition and analysis of data. RM contributed to the drafting, writing and critical reviewing of the manuscript. WH and DG conceived the project and initiated development of the evaluation, contributed to the writing and critical reviewing of the manuscript, development of methods, analysis of data and interpretation of results. Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript.
Funding The Bristol Self-harm Surveillance Register is funded by AWP NHS Trust and Bristol City Council. We thank all members of University Hospitals Bristol NHS Foundation Trust's Liaison Psychiatry team, in particular Salena Williams (team leader) and Kat Bramley and Peter Kennedy-Chapman (data collection) for their role in data collection and Dr Robert Carroll and Dr Dee Knipe for data preparation. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Research data set is available on request for verification of the data analyses.
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