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Original papers: Nikki O’Keeffe, Umesh Sira Ramaiah, Erum Nomani, Michelle Fitzpatrick, and Gopinath Ranjith Benchmarking a liaison psychiatry service: a prospective 6-month study of quality indicators Psychiatr Bull 2007; 31: 345-347 [Abstract] [Full text] [PDF]

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Liaison Benchmarks: More attention needed

Dr. Mukesh Kripalani, Lyn Williams, Dr. Amanda Gash   (11 October 2007)

Liaison Benchmarks: More attention needed 11 October 2007
Dr. Mukesh Kripalani, Specialist Registrar Royal College of Psychiatrists, Lyn Williams, Dr. Amanda Gash Send letter to journal: Re: Liaison Benchmarks: More attention needed drmukesh{at}doctors.org.uk Dr. Mukesh Kripalani, et al.	Liaison Benchmarks: More attention needed We read with interest the article on Bench-marking liaison services in the Sept 2007 edition of the Psychiatric bulletin, especially as we are undergoing a review of our liaison services as a part of the Foundation Trust process. Many of the points raised in the article on the value of Liaison services have been discussed in various forums across our Trust. We are frustrated by the fact that people see us as expensive and that there is no national target directly aimed at Liaison services. Despite this, we do support and work with various national priorities such as the 4 hours A&E waits (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4121900) and Suicide Prevention strategies (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4121900 ). The Bench-marks raised in this article are laudable but we do have some questions on their validity. We accept they may have been used before but, in the UK sense, it may not be directly comparable. We agree with indicator 1: “all referrals to be seen by the end of next working day”. However, we give the referrer the ability to prioritise as urgent (within 24 hours) and non-urgent (within 48 hours). Regarding indicator 2: “all referrals following self-harm to be seen by the end of same day”, could we clarify that these patients are seen even before they are medically fit, i.e. in A&E / referred any time during the day? Our audit in 2003 revealed approximately 80% of patients attending A&E following self-harm were admitted to general wards of the acute hospital, on medical grounds. Indicator 3 is taken for granted in 100% cases and is already a standard. We were disappointed with indicator 4: “all consultations to be discussed with supervising psychiatrist by the end of next working day” since all our assessments are discussed within a couple of hours with the supervising psychiatrist. We feel this is a priority as we can streamline effective management plans and share the burden of risk. This has been noted as an example of excellent practice by the Coroner even when untoward outcomes have occurred. We were surprised that a large teaching hospital such as St. Thomas’s had just 145 referrals in a 6 months period. Moreover just 33 patients had self-harmed. Of the 109 who had a clear reason for referral, 6 could not be accounted for. By comparison, we had 785 self-harm referrals and 101 liaison referrals in the period Jan 2007 to June 2007. Total number for 6 months was 886 patients. Finally we agree with the tenet of the article that obtaining a national benchmark in Liaison Psychiatry would help to acknowledge the skills we employ and the work we all do. Acknowledgements: The Liaison Psychiatry team Authors: Dr. Mukesh Kripalani, Specialist Registrar, Liaison Psychiatry. Lyn Williams, Nurse Consultant, Liaison Psychiatry. Dr. Amanda Gash, Consultant Psychiatrist, Liaison Psychiatry. Declaration of interest: All three work with in the Liaison Psychiatry team.