Faculty of Liaison Psychiatry – Royal College of Psychiatrists
JISC UPDATE November 2012
Shared care ward experience
A Liaison psychiatrist asks: ‘Kent and Medway Acute Trusts are interested in considering the
use of some Shared Care Wards, most likely for complicated cases of physical health and
delirium/cognitive impairment.
Does anybody have experience of this model and would anybody be willing to share an
operational policy or protocols?
We would be particularly interested as to how the RMNs interface with the RGNs and the
management structure(s) associated with this.’
One respondent noted quite a difference between shared care wards for the elderly and the
more general medical. The person much experience of the latter is Chris Ryan from
Australia. There is also a short bibliography in an article Dave Protheroe wrote for The
Psychiatrist some years ago.
Another respondent said there had been a vogue e.g. Tom Arie’s ward in Nottingham many
years’ ago; but now putting liaison psychiatric staff into medical wards seems to be more
popular (latterly influenced very much by Sharon Inouye's work). He also suggests speaking
to John Holmes (who said ‘Gateshead and York both have shared care wards for older
people. The York contact is Lance Middleton’) in Leeds or Ian Anderson from Liverpool as
two old age liaison psychiatrists.
Assessment forms, outcome measures and data sets for Liaison
I (JG of Worthing!) find these discussions can get a bit confusing. On the one hand, with
commissioners looking for important things to purchase we need to say ‘here is my essential
product, this is how much you need and this is the unit cost – and here is the evidence that I
have provided it’. We also have computerised systems with which to write up our assessments
(the meat of what we do) – which are related to outcomes, but different. If only the complex
clinical activity we do (quick response time, full assessment, diagnosis, care plan, educating
staff etc etc) - and record - automatically generated the invoice! And the trouble with HoNOS
is that there is a before and after requirement – but we often just see the once in Liaison.
Anyhow, this was the discussion (and one which we have had often on this site).
One liaison service (which uses Rio) has negotiated a formal agreement with their governance
department (via a trust-wide Liaison Clinical standards group) that they use a minimum data
set assessment as opposed to full RIO recording and also that we do not use FACE in Liaison.
They are building in the ability to upload this assessment (written as a word template) without
the need for cutting and pasting. It then also forms a letter to GP and can be put into acute
hospital medical notes.
They have a current narrative tool (as an alternative to FACE) identifying static/current risks,
external hazards and mediating factors and a narrative formulation and plan. Assuming it is
approved and it has a lot of internal impetus, this will be able to be used in certain other
clinical settings (e.g. by on-call medics, in A&E, or for those people who are only seen in
CMHT outpatient clinics with non-enhanced care needs).
A clinician’s thoughts on Rio: This service is not going live on RiO until late 2013 and is
looking for agreement about when and how Liaison uses it, ‘as the figures in terms of
workload is worrying to me i.e. reduction in "productivity" by 30 to 50 %’.
He wonders if data on diagnosis, physical co-morbidities, number of attendances and
admissions, number of bed days, need for ‘specialling’ would make the beginnings of a useful
data set.
‘I was also a bit surprised that many of the Liaison services using RiO do not use it to keep
track of things like response times...it seems to me that the wait list function in RiO may be
best at this and this is what I will be exploring...any other experiences out there?’
Two South London Liaison Psychiatrists are in the process of finalising a version of HoNOS
for use in liaison; with Dr Mick Jones (who has been involved with developing the original
HoNOS). This will be presented at the liaison executive meeting for comments. They then
plan to consult more widely amongst our peer group, before trialling it in a more structured
way.
Respondents from Australia and Kent were both keen to trial this new tool when available.
Jackie Gordon
Worthing