A Quality Improvement Project: Improving the Presentation of Assessments Within a Liaison Psychiatry Department

Abstract

AimsThis Quality Improvement Project (QIP) was undertaken within a Liaison Psychiatry (LP) department at a district general hospital in North West London. The current service model has LP nurses and junior doctors providing first contact with patients, and subsequently discussing assessments with the team psychiatrists. A need for effective communication when presenting clinical cases has emerged given high rates of staff turnover. The aims of this QIP were; (1) To assess the quality of presentations within the multidisciplinary team (2) to deliver a targeted teaching session focused on frameworks for assessment presentation and (3) to evaluate the effectiveness of the intervention.MethodsThe ‘SBAR: Situation, Background, Assessment, Recommendation’ communication tool already used widely within healthcare was adapted for LP by an MDT including doctors, senior nurses and pharmacist.A survey was designed with MDT input to collect data about the content of presentations using adapted Likert scales, a quantitative global score and qualitative data highlighting areas for improvement. Over two weeks, senior team members completed surveys for every patient discussion.A targeted teaching session was delivered on the adapted LP SBAR including: presenting complaint, current medical issues, referral question, psychiatric background, mental state examination, delirium/cognitive screening, risk assessment, impression and management plan. The session included breakout groups with clinical vignettes to practice presenting. All team members filled in a pre- and post-intervention surveys rating their confidence in presenting assessments and received copies of teaching materials.Data were collected over a 2-week period post-intervention using the same methodology as pre-intervention. Post-intervention data were presented to the MDT and feedback was sought for improvement in the next cycle.ResultsPre-intervention data (n=30) indicated a risk assessment, impression and plan were often missed from presentations.Following targeted teaching, team members felt more confident presenting assessments, formulating impressions, and management plans. Post-intervention data (n=22) showed an improvement in inclusion of all key information covered in the LP SBAR except management plans. The percentage of presentations with a global score ≥7 increased from 41% to 57%.ConclusionThis ‘Plan, Do, Study, Act’ cycle has modestly improved the quality of assessment presentations within LP and has identified a critical need for communication tools within LP. We will perform another cycle in February 2023 given the high turnover of staff and continue to seek feedback from the MDT on the effectiveness of this targeted teaching session to continue to improve the presentation of assessments in LP.