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Determinants of Good Emergency Care for Mental Health Patients

Winter, Anna-Elizabeth Moore; (2019) Determinants of Good Emergency Care for Mental Health Patients. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Background: The quality of accident and emergency (A&E) care is identified as a policy priority for mental health (MH) patients and is currently measured by the four-hour treatment target. A&E departments struggle to meet this and there is little research into how to best approach improvement. Aim: To understand the incidence of mental health problems in A&E, what constitutes good quality care from the patient’s perspective and the factors contributing to breaches and length of stay (LOS). Methods: A meta-analysis of the incidence of mental health problems in A&E, a preliminary study exploring the feasibility of collecting real-time data and a mixed-methods cross-sectional multi-site study exploring the factors associated with LOS and breach were undertaken. Analyses included multiple regression models predicting LOS and breach. Loglinear analysis explored the mediating effect of sites. A qualitative thematic analysis investigated experience and preferences for emergency mental health care. Results: The incidence of mental health attendances in the A&E was ~4%. These individuals represent high psycho-social need and experience of care was predominantly poor. Patients prefer not to attend A&E however difficulty with timely access to help meant most saw this as the only option. The characteristics of an ‘ideal service’ are identified. The relative risk of mental health breach was 4.2 with significant variation between sites. Six mediating factors helped explain these differences. 56% of the variation in LOS was predicted, with throughput factors the largest contributors. Conclusion: It was possible to estimate the incidence of mental health attendances in A&E. The pilot demonstrated the feasibility of real-time collection of data in A&E. The mixed-methods study estimated the relative risk of breach, provided some explanation in the variability of length of stay and breach, and explored patient experience and preferences for emergency mental health care. Recommendations for service improvement were made.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Determinants of Good Emergency Care for Mental Health Patients
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/10081414
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