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Title: Determinants of good emergency care for mental health patients
Author: Winter, Anna-Elizabeth Moore
ISNI:       0000 0004 8500 4376
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available