The mental health services question this study addresses is, more accurately: if you have two psychiatric wards in a hospital, should you convert one of them to a crisis resolution team. The answer is definitely yes.
Some background.: crisis resolution teams in France are called EPSIAD, which stands for Equipe Psychiatrique de Soins Intensif A Domicile , which translates as Psychiatric Intensive Home Care Team. These teams closely follow the UK CORE good practice guidelines ( see my March 18 2020 post on CORE).
In this study, a hospital ward was converted into an EPSIAD in the Jury Psychiatric Hospital in North-Eastern France.
A quasi-experimental design was used to compare several quality indicators of patient mental health care , one year before ,and one year after the change.
During first study period , Period 1, the service comprised two inpatient wards each with 20 beds. In September 2021 the staff members of these two wards were reassigned either to the new inpatient ward or the EPSIAD team. In the second study period, Period 2 the service comprised one inpatient ward with 20 beds and an EPSIAD team with a capacity of 20 patients.
All patients in need of intensive psychiatric care can be referred to crisis resolution team with the exception of patients with a high suicidal risk, patients with a high risk of aggressive behaviours, homeless patients and patients refusing care. The team accepts referrals from all sources, the initial evaluation is conducted by phone and a face-to-face interview is organized within the next 48 hrs to confirm admission, otherwise the patient is referred to a different type of care.
Results:
Before the change 293 patients were treated in a year. During the first year after the change, 103 more patients were treated ( 396vs293)
Hospital admissions were reduced by 48 ( 245 vs 293)
In Period 2 there was a significant difference in gender with more patients admitted to the crisis resolution team being female ( 62.9 % females admitted to crisis resolution team vs 41.2 % females admitted to hospital )
There was a significant increase in the proportion of voluntary admissions ( 52% vs 36.2 %)
There was a significant reduction in median length of hospital stay from 17 days to 12 days . The hospital length of stay was reduced for 7.3 % of patients by transferring them to crisis resolution team. In 55.2 % of these transfers , legal status changed from involuntary to voluntary admission.
There was an increase in satisfaction with the service as a whole after the crisis resolution team was introduced, particularly in clarity of information , relationship with care staff and service and degree of involvement in medical decisions.
One of the objectives for the improvement of quality of care was to reduce involuntary admissions. Although the proportion of involuntary admissions decreased significantly in the service as a whole, the total number was identical before and after the introduction of the crisis resolution team. Since the total number of hospital admissions decreased but the number of involuntary admissions remained the same despite the closure of an inpatient ward ,it is unsurprising that the proportion of involuntary admitted patients in the remaining ward increased to nearly three quarters of admissions. This has a direct implication for the remaining inpatient ward with a higher concentration of more complex patients to treat.
Conclusions:
The combination of a hospital ward with a crisis resolution team has the potential to increase global quality of care by providing a complementary mental health service. Crisis resolution teams may provide a viable alternative to hospitalization that increases patient satisfaction and allows new patients to receive intensive care.