In 2014, Bristol Clinical Commissioning Group commissioned University Hospitals Bristol NHS Foundation Trust to extend the operating hours of its liaison psychiatry service at the Bristol Royal Infirmary’s emergency department. The service was extended because most emergency department patients who have self-harmed present outside office hours, and are less likely to receive specialist assessment and aftercare.
This change, from 40 hours over five days to 98 hours over seven days a week, needed an additional investment of around £250,000 per year.
The aims were to:
- increase the proportion of patients receiving a NICE-recommended psychosocial assessment when attending the emergency department after self-harming
- reduce hospital admissions for patients awaiting a specialist psychosocial assessment
This study focused on the impact of this service change on self-harm patients because they make up a high proportion of the liaison team’s workload, are the patient group at highest risk of suicide and have detailed data collected about their care through the local self-harm register. It was this detailed data that made this evaluation possible. They also may have to wait in the emergency department or be admitted to hospital if they can’t have a timely psychiatric assessment.
This project was a collaboration with STITCH, the Bristol Health Partners Health Integration Team (HIT) that focuses on improving care for people who self-harm.
The study compares the short-term costs of extending the liaison psychiatry service for self-harm patients at the Bristol Royal Infirmary, in a before and after study. We used existing data about acute self-harm episodes.
The results will enable commissioners to explore whether the extra investment increased assessment and provision rates, and reduced hospital admissions for self-harm in the short-term after a self-harm episode.
What we did
We compared attendances at the emergency department during a three month period before the change in operating hours, to attendances during a similar three month period afterwards.
We looked at:
- whether patients received an assessment from the liaison psychiatric service
- the waiting time until the assessment
- whether patients were admitted to a hospital ward
We also estimated average costs per emergency department attendance and compared total costs between the before and after periods.
How we involved people
Staff from the liaison psychiatry service were central to the success of this project. They helped us with their expertise on the data, considering how to carry out the evaluation, and interpreting the results.
What we found and what this means
About 10 per cent more patients received a psychosocial assessment following the change to extended Psychiatric Liaison team operating hours. The waiting time for an assessment decreased by more than three hours. In 2015 with the new hours in place, patients were 20 per cent less likely to re-attend for self-harm within 90 days.
The findings also show that, over a three-month period, the initial investment in the extended service may lead to a saving of £36,150 in emergency department and hospital costs, for this specific group of patients. This equates to £144,600 annually.
However, because the study only covered a short three-month period and relatively small number of patients, these results are preliminary. A larger study is needed to provide stronger evidence on costs and re-attendance.
Our study will help commissioners across England judge whether further investment in liaison psychiatric services represents value for money.
This study only compared two short periods. It didn’t look at whether there were improvements in patients’ health, or how frequently patients used other services after involvement with the liaison psychiatry service.
The service extension is likely to benefit other patient groups, but we were only able to look at data for patients who had self-harmed.
We hope to do more analysis that includes health outcomes and follow-up care, and look at more patients over a longer period. This further work will allow us to provide a more complete picture and more robust results.
CLAHRC BITE (Brokering Innovation Through Evidence)
Evaluation of new investment in liaison psychiatry services at University Hospitals Bristol
This CLAHRC BITE gives the highlights from this research project in a printable A5 format.Download the BITE
Links and downloads
- Extending the liaison psychiatry service in a large hospital in the UK: a before and after evaluation of the economic impact and patient care following ED attendances for self-harm Read the full paper
- Improving Care in Self-Harm HIT's successes in 2016-17 Read more about STITCH HIT
- Two Health Integration Teams responsible for £340,000 savings annually STITCH contributes to £340,000 savings annually
- News story: In numbers: STITCH HIT's successes STICH HIT's successes
- Mental Health HIT seminar proves a hit with commissioners News from Bristol Health Partners