Abstract
AimsReferrals to the psychiatric Liaison team in A&E seem to come in the afternoon in kismet as the day shift is ending. This study looked at the timing distribution of referrals to try improve amount of jobs being handed over to the evening shifts.MethodReferrals made to Homerton University Hospital (HUH) psychiatric liaison was parsed into 1 hour bins and plotted as a histogram (data between August 2016–October 2019. N = 14182). The data were compared to diurnal human body temperature variation, as well as data published on Hospital Accident & Emergency Activity 2019–20 (digital.nhs.uk) for Ambulance attendances.ResultReferrals to HUH liaison team appear to closely follow the average human body temperature variations per hour (Pearson Correlation coefficient = 0.90). A peak appears to occur around 4 PM, and a low at 7AM. The referrals data also mirrored timings of official Hospital Episode Statistics (HES) reports 2019–2020 for ambulance attendance in England (Pearson Correlation coefficient = 0.94).ConclusionAttendance to A&E and referrals to psychiatric liaison appear correlated to a circadian bound rhythm. “The 4PM referrals rush” appears to be a genuine phenomenon replicated in not only HUH mental health referrals, but general ambulance attendance throughout all of England. The body temperature analogue for circadian rhythm may be humorously applied here to correlate with the increased referral rates to A&E; the emergency department could be said to be truly heating up in the afternoon. Indeed temperature and activity has already been shown to link strongly via the Arrhenius equation in cricket activity such as chirps per minute. The conclusions drawn here are that acute mental health attendances, like general health attendances as a whole follow underlying but powerful patterns, and provisions might best be allocated to address this rather than thinking of fixed 9-5 working schedules.
Highlights
This evaluation aims to understand if Cognitive Behaviour Therapy (CBT) cases for Core Psychiatry Trainees (CPTs) in Sheffield provide good training in therapy skills and if these can be integrated into general psychiatric practice
CPTs who had completed a clinical case in CBT at a tertiary psychotherapy service were identified
The results showed a significant impact on trainees understanding of CBT, applying theory to clinical context, and changed future practice
Summary
This evaluation aims to understand if Cognitive Behaviour Therapy (CBT) cases for Core Psychiatry Trainees (CPTs) in Sheffield provide good training in therapy skills and if these can be integrated into general psychiatric practice. Completion of psychotherapy cases part of the curriculum for CPTs, with cognitive behavior therapy being one of the common modalities used. Whilst there is evidence that trainees often provide competent therapy it is unclear what cases are appropriate and how these contribute to wider CPT learning objectives. CPTs who had completed a clinical case in CBT at a tertiary psychotherapy service were identified.
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