Reducing Variability in the Management of Children and Young People Admitted to Hospital with Mental Health Problems
Paediatric QI Fellow Project Interim Report, January 2017
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Background
Young people with mental health problems form a particularly complex and vulnerable patient group, and can pose significant challenges when admitted to hospital acutely. During a hospital stay, they may be managed by a number of different teams, including CAMHS, Paediatrics and ED.  Communication and joint working between these teams is often limited, which can lead to significant variability in the care these patients receive.

Project Aims (what are we trying to accomplish)
Improve communication and joint working between the various teams involved in managing these young people in hospital, with the aim of reducing variability in the care they receive.

Brief description including setting (e.g. ward based, community etc)
We are initially focusing on two centres which are both covered by the same OOH CAMHS team. ED, Paediatrics and CAMHS departments are all involved.
 
How will we know a change is an improvement? (what are your measures?)
Measures will mostly be qualitative, assessing the change in attitudes and experiences in professionals involved in these patients’ care. We will also look at documentation in notes and handover practices between teams.

Progress to date
Following meetings with Paeds, CAMHS & ED staff in both hospitals, a questionnaire was developed & distributed to assess the principal concerns of those managing these patients. 60+ have been returned.  Issues highlighted include the care of patients with acute behavioural disturbance, poor communication between teams & lack of community support.

Free multidisciplinary study days on Acute Behavioural Disturbance are being organised for both hospitals, to take place in the spring and summer. We are also organising team debriefs on challenging patients, to include all three specialties. Additionally, a buddy system to pair Paediatrics trainees in core Community placements with local CAMHS trainees is being developed and will be piloted in three areas from March.

Lastly, we are hoping to finalise a regional guideline on Rapid Tranquillisation in Young People.

Next steps
Running pilot study days and debriefs in each hospital.
Finalising the Rapid Tranquillisation guideline and putting it through PIER governance.

Project lead, role and contact details
Katya Certic, ST5 Paediatrics and QI Fellow - k.certic@nhs.net

Useful Resources
http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1570