Citation

Jackson J, Nugawela MD, de Vocht F, Moran P, Hollingworth W, Knipe D, Munien N, Gunnell D, Redaniel MT. BJPsych Open 2020; 6(3): e34.

Affiliation

The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust; and Population Health Sciences, Bristol Medical School, University of Bristol, UK.

Copyright

(Copyright © 2020, Royal College of Psychiatrists)

DOI

10.1192/bjo.2020.18

PMID

32238204

Abstract

BACKGROUND: In September 2014, as part of a national initiative to increase access to liaison psychiatry services, the liaison psychiatry services at Bristol Royal Infirmary received new investment of £250 000 per annum, expanding its availability from 40 to 98 h per week. The long-term impact on patient outcomes and costs, of patients presenting to the emergency department with self-harm, is unknown. AIMS: To assess the long-term impact of the investment on patient care outcomes and costs, of patients presenting to the emergency department with self-harm.

METHOD: Monthly data for all self-harm emergency department attendances between 1 September 2011 and 30 September 2017 was modelled using Bayesian structural time series to estimate expected outcomes in the absence of expanded operating hours (the counterfactual). The difference between the observed and expected trends for each outcome were interpreted as the effects of the investment.

RESULTS: Over the 3 years after service expansion, the mean number of self-harm attendances increased 13%. Median waiting time from arrival to psychosocial assessment was 2 h shorter (18.6% decrease, 95% Bayesian credible interval (BCI) -30.2% to -2.8%), there were 45 more referrals to other agencies (86.1% increase, 95% BCI 60.6% to 110.9%) and a small increase in the number of psychosocial assessments (11.7% increase, 95% BCI -3.4% to 28.5%) per month. Monthly mean net hospital costs were £34 more per episode (5.3% increase, 95% BCI -11.6% to 25.5%).

CONCLUSIONS: Despite annual increases in emergency department attendances, investment was associated with reduced waiting times for psychosocial assessment and more referrals to other agencies, with only a small increase in cost per episode.

Language: en

Keywords

Self-harm; emergency department; liaison psychiatry service