Q Exchange
Improving the Psychiatric Decisions Unit (PDU) in Sheffield
- Proposal
- 2024
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Nationally, mental health patients account for 16% of all 12-hour waits in A&E, and approximately 3% of overall A&E attendances. Some of these patients do not require physical health input, and instead wait for a crisis assessment by mental health liaison teams who are themselves stretched.
Currently, Yorkshire Ambulance Service attend mental health patients in crisis and transport them to A&E to await an assessment, some of which could instead attend the PDU.
Previous interactions within Sheffield Health and Social Care, Sheffield Teaching Hospitals and YAS highlighted a lack of awareness and understanding of the PDU and its uses. There is an existing collaboration with the ICB to improve the Urgent and Emergency Care (UEC) pathway. This highlights the need for more education and training across Trusts to promote a more collaborative way of working.
Alongside these Trusts, we will work with our partner charity, Sheffield Flourish, to incorporate service user feedback.
What does your project aim to achieve?
To improve the utilisation of the PDU, provide a better patient experience and reduce demand for mental health support within Sheffield’s A&E. Patients bypassing A&E and attending the PDU experience a quieter, more appropriate environment and be assessed by mental health professionals quicker, in keeping with the NHS principle of right person, right place, right time.
Increase referrals to the PDU by 30% by July 2026, through training, education and increased dissemination of information regarding the PDU.
Health inequalities were highlighted in our Trust’s 2023 data. There is overrepresentation on the PDU of those from deprived areas and disparities in the proportion of people from the LGB communities and certain ethnicities when compared to Sheffield’s population. By involving Service users and carers we aim to address this issue.
There are existing partnerships between SHSC, STH, YAS and third sector organisations and previous training has been provided but there is demand for more.
How will the project be delivered?
Phase 1: Information gathering.
Survey SHSC staff regarding current knowledge of the PDU as baseline data.
Review PDU capacity usage and inappropriate referrals.
Meet with STH and YAS to produce fishbone diagrams to visualise the current A&E pathway, processes, and measurable outcomes such as waiting times for mental health.
Gather feedback from service users with lived experience of the PDU to help develop educational packs.
Phase 2: Develop education packs/training sessions.
Using information gathered in Phase 1, develop appropriate resources and training sessions for SHSC staff, A&E staff.
Coproduce service user information with support from Sheffield Flourish (VCSE).
Work with other organisations (e.g. SayIt) to ensure our training considers health inequalities.
Phase 3: Deliver training
Using PDSA methodology, deliver sessions across SHSC and YAS as required.
Work with Sheffield Flourish to provide information to service users.
Phase 4: Ongoing evaluation
Repeat SHSC staff survey about PDU knowledge.
Review PDU data.
Share learning with others.
How is your project going to share learning?
There are only six PDUs across the UK, therefore projects such as this where we are testing and improving how to effectively use the service will be valuable to other PDUs as well as areas considering whether to invest in setting up their own PDU.
We have reached out to existing PDUs who have different ways of running their services and there has been interest in a shared learning platform.
There may also be learning for other A&E departments and Ambulance services where there are not existing PDUs who may want to consider their pathways.
We aim to attend conferences to share our learning nationally.
How you can contribute
- Provide comments and feedback on this project.
- Networking opportunities with other mental health trusts interested in PDU implementation.
- Experience of effective co-production.
- We welcome any other organisations who may wish to be involved.
Plan timeline
| 8 Jul 2024 | Begin Phase 1 |
|---|---|
| 2 Sep 2024 | Begin Phase 2 |
| 3 Feb 2025 | Begin Phase 3 |
| 7 Apr 2025 | Begin Phase 4 |
Comments
Louisa King 20 Mar 2024
The proposals in this project are really positive, and it is encouraging to see the support the proposal has from difference partners in Sheffield, including the VCSE sector.
I am really interested in the health inequalities aspect highlighted in the proposal above in particular. Can you highlight which groups specifically you will be working with, and the VCSE groups you will partner with?
I am also interested in how this might support young people aged 16/17 attending adults' A&E. Have you considered this?
Holly Smith 20 Mar 2024
Thank you for your comment Louisa.
We have already reached out to Flourish and plan to be guided by service user groups to identify which groups we can engage with and would see the most benefit from.
We have existing partnerships with SACHMA and the Pakistan Muslim Centre and plan to reach out to them to discuss how we can help to address the inequalities in those communities, which we already know exist from previous data.
We would like to build a relationship with Say It too. We have considered approaching this via our Rainbow Staff Network as they already have a connection.
As for 16/17 year olds, that is an excellent question that unfortunately I don't have an answer for. The PDU is not commissioned for 16/17 year olds though we do know that age group attend the adult A&E for emergency care only, but the secondary mental health is not provided by SHSC but by CAMHS which is under SCH. It is something that would be interesting to look at moving forward but I do not have an answer for you as yet.
Richard Hammond 14 Mar 2024
Is there a role for the police in this project? I would imagine we are a significant contributor to the number of individuals in A&Es for a mental health related issue, whether that be formally detained or on an informal basis. I have a lot of data regarding the time police officers spend in A&E with those detained under S136, due to the lack of available S136 specific beds. I do wonder if some of those detentions would occur / are necessary, if there was a known viable alternative. More than happy to discuss further.
Holly Smith 18 Mar 2024
Thank you for your comment Richard. Yes we would welcome input from police, I can only imagine how much time police officers spend in A&E with patients detained under S136. Legally if a patient is detained a place of safety i.e. A&E or a 136 bed are the only options but yes I wonder if police were aware there was an alternative and could liaise with the PDU and transport patients to the PDU directly (the patient would have to consent to this) this may also contribute to reduced A&E admissions.
Chris Powell-Wiffen 11 Mar 2024
This sounds like an excellent (and cost effective) way of helping patients access the best service for their needs earlier whilst reducing pressure upon Sheffield's 'physical health' urgent and emergency care services.
Jessica Anderson 27 Feb 2024
Hi, this sounds like a really interesting idea. I'd be really keen to learn more about how you're planning to deliver the training?
Jenny Marshall 27 Feb 2024
Good question, and one that will depend largely on the information we receive during the scoping process in Phase 1. As we'd like to work with a variety of sectors, we'd like to provide training that is most appropriate to the service, whether that's group sessions of in-person/online training led by a facilitator, website resources and videos for more bitesize learning, or materials such as leaflets and information booklets.
Helen Crimlisk 23 Feb 2024
This project illustrates the challenges of ensuring that innovative approaches to breaking longstanding referral routes are understood and actioned across system boundaries. PDUs are a fabulous way of supporting patients in crisis because of their mental health. They deliver a more appropriate environment, improved patient experience and free up space and time in A&E for those who need urgent physical health interventions. The engagement with networks and dats gathering around staff awareness and views, especially with the explicit focus on inequalities, will add value to understanding and also prompt stafg to considef how bedt to engage with wider system partners sch as YAS, STH,SHSC & VCSE to ensure this resourse is used effectively and equitably. The explicit involvment of partners such as SAYIT and Flourish demonstrstes a determination to work in partnership across systems.
How will you ensure the impact of this intervention and data collection will be shared with other PDUs and also support commissioners elsewhere to consider this approach?
Have you thought about how often issues of concerns re patient safety and also of patient choice play into decision making?
Holly Smith 4 Mar 2024
Thank you for your comment Helen, as Jenny has already said I have previously been in contact with other PDUs in the country to start the process of shared learning from each other, it was evident from those meetings that each unit operates quite differently, and we could all learn a lot from each other. I recently reached out again to the contacts from those PDUs to gain an understanding for the appetite for shared learning and my enquiries were met with enthusiasm.
With regards to your second question, we have linked in with a current quality improvement project happening on the PDU, the focus of which is improving the service out of hours from a medical cover perspective, which is hoping to address and highlight any safety concerns. As for patient choice, interesting question, one of the things we would like to do with this project is have substantial service user involvement, particularly feedback on the unit itself and the referral and discharge process, this is possibly one of the areas where Flourish or our in house Peer Support workers may be helpful.
Jenny Marshall 27 Feb 2024
Thanks Helen, some great points and questions raised here for consideration.
Holly has been in contact with other PDUs and I'm sure will be pleased to share the findings from this project if we're successful in securing funding. We have a separate workstream aiming to set up a PDU community/network, an idea which has received interest during conversations with national PDU colleagues.
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