Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport)

摘要

Background: Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods: Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results: The new Rapid Assessment Interface and Discharge service assessed 339?patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04?years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 ( P <0.001, paired t -test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20?days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2?days), leading to a total annualized bed savings of 44?days. FI was the most highly significant factor between patient groups with a good and poor outcome ( P =0.00003, independent groups t -test, t =-4.38, df 98). Conclusion: Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes.