Evaluation of a nurse practitioner-led extended hours mental health liaison nurse service based in the emergency department
Timothy Wand A D , Natalie D’Abrew B , Catherine Barnett B , Louise Acret B and Kathryn White CA University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
B University of Sydney, NSW 2050, Australia. Email: Natalie.dabrew@sydney.edu.au; cathy.barnett@sydney.edu.au; louise.acret@sydney.edu.au
C Sydney Nursing School, University of Sydney (MO2), NSW 2050, Australia. Email: kate.white@sydney.edu.au
D Corresponding author. Email: timothy.wand@sswahs.nsw.gov.au
Australian Health Review 39(1) 1-8 https://doi.org/10.1071/AH14100
Submitted: 27 June 2014 Accepted: 16 September 2014 Published: 13 November 2014
Abstract
Objective To evaluate a nurse practitioner (NP)-led extended hours mental health liaison nurse (MHLN) service based in the emergency department (ED) of an inner city teaching hospital in Sydney and to explicate a model of care that is transferable across a broad range of ED settings, both in metropolitan and rural contexts.
Methods This mixed-methods evaluation encompassed descriptive data on ED mental health presentations, quantifying waiting times for MHLN involvement and interviews with MHLN team members at the commencement of the evaluation and 12 months later. Interviews were also conducted with a snapshot of ED patients, and a sample of ED and psychiatry staff.
Results The expanded MHLN service was rapidly incorporated into the ED structure, enthusiastically endorsed by ED patients and highly valued by staff and the organisation. The MHLN team saw 55% of referred patients within the first hour of arrival (frequently before medical assessment), thereby initiating and expediting co-ordination of care at an early stage of the ED process.
Conclusions An NP-led extended hours MHLN team based in the ED provides prompt and effective access to specialised mental health care for people with ‘undifferentiated health problems’, and removes a significant workload from nursing and medical staff. Embedding the NP-led MHLN service within the ED structure was pivotal to the success and sustainability of this model of care.
What is known about the topic? Mental health liaison nurse (MHLN) services have existed in emergency departments (EDs) in Australia and internationally for many years. However, there is great variation in the way these services are structured and no standardised model of care has been explicated.
What does this paper add? Findings from this evaluation indicate that a nurse practitioner-led extended hours MHLN service integrated within the ED team structure provides prompt access to specialised mental health care to people with undifferentiated health problems, and removes a significant workload from ED nursing and medical staff.
What are the implications for practitioners? Mental health nurse-led service provision based in the ED is a safe, flexible and effective method of enhancing access to health care that is adaptable to broad range of settings. ED ownership of this model of care is pivotal to the successful implementation and sustainability of MHLN services.
References
[1] Tankel AS, Di Palma MJ, Kramer KM, van der Zwan R. Increasing impact of mental health presentations on New South Wales public hospital emergency departments 1999–2006. Emerg Med Australas 2011; 23 689–96.| Increasing impact of mental health presentations on New South Wales public hospital emergency departments 1999–2006.Crossref | GoogleScholarGoogle Scholar | 22151667PubMed |
[2] Commonwealth of Australia. Fourth National Mental Health Plan – an agenda for collaborative government action in mental health (2009–2014). Canberra: Australian Government Publishing Service; 2009.
[3] Roberts D. Liaison mental health nursing: origins, definition and prospects. J Adv Nurs 1997; 25 101–8.
| Liaison mental health nursing: origins, definition and prospects.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s7lslOgug%3D%3D&md5=0de6f436d6274ede20eff1e20f978edcCAS | 9004017PubMed |
[4] Wand T, White K. Examining models of mental health service delivery in the emergency department. Aust NZ. J Psychiatry 2007; 41 784–91.
| Examining models of mental health service delivery in the emergency department.Crossref | GoogleScholarGoogle Scholar |
[5] Wand T, Fisher J. The mental health nurse practitioner in the emergency department: an Australian experience. Int J Ment Health Nurs 2006; 15 201–8.
| The mental health nurse practitioner in the emergency department: an Australian experience.Crossref | GoogleScholarGoogle Scholar | 16916414PubMed |
[6] Nicholls D, Gaynor N, Shafiei T, Bosanac P, Farrell G. Mental health nursing in emergency departments: the case for a nurse practitioner role. J Clin Nurs 2011; 20 530–6.
| Mental health nursing in emergency departments: the case for a nurse practitioner role.Crossref | GoogleScholarGoogle Scholar | 21219526PubMed |
[7] Wand T, White K, Patching J, Dixon J, Green T. An emergency department based mental health nurse practitioner outpatient service: Part 1, participant evaluation. Int J Ment Health Nurs 2011; 20 392–400.
| An emergency department based mental health nurse practitioner outpatient service: Part 1, participant evaluation.Crossref | GoogleScholarGoogle Scholar | 21457179PubMed |
[8] Wand T, White K, Patching J, Dixon J, Green T. An emergency department based mental health nurse practitioner outpatient service: Part 2, staff evaluation. Int J Ment Health Nurs 2011; 20 401–8.
| An emergency department based mental health nurse practitioner outpatient service: Part 2, staff evaluation.Crossref | GoogleScholarGoogle Scholar | 21457178PubMed |
[9] Wand T, White K, Patching J, Dixon J, Green T. Outcomes from the evaluation of an emergency department based mental health nurse practitioner outpatient service. J Am Acad Nurse Pract 2012; 24 149–59.
| Outcomes from the evaluation of an emergency department based mental health nurse practitioner outpatient service.Crossref | GoogleScholarGoogle Scholar | 22404793PubMed |
[10] Wand T, Happell B. The mental health nurse: contributing to improved outcomes for patients in the emergency department. Accid Emerg Nurs 2001; 9 166–76.
| The mental health nurse: contributing to improved outcomes for patients in the emergency department.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2Fjtl2lsQ%3D%3D&md5=b7e69d0582384fb6c1c4272cc1e7ba8bCAS | 11761872PubMed |
[11] Wand T. Mental health liaison nurses in the emergency department: on-site expertise and enhanced coordination of care. Aust J Adv Nurs 2004; 22 25–31.
| 16499244PubMed |
[12] Wand T, Schaecken P. Consumer evaluation of a mental health liaison nurse service. Contemp Nurse 2006; 21 14–21.
| Consumer evaluation of a mental health liaison nurse service.Crossref | GoogleScholarGoogle Scholar | 16594877PubMed |
[13] Wand T, White K. Exploring the scope of the emergency department mental health nurse practitioner role. Int J Ment Health Nurs 2007; 16 403–12.
| Exploring the scope of the emergency department mental health nurse practitioner role.Crossref | GoogleScholarGoogle Scholar | 17995511PubMed |
[14] Wand T, White K, Patching J. Refining the model for an emergency department based mental health nurse practitioner outpatient service. Nurs Inq 2008; 15 231–41.
| Refining the model for an emergency department based mental health nurse practitioner outpatient service.Crossref | GoogleScholarGoogle Scholar | 18786216PubMed |
[15] Johnson RB, Onwuegbuzie AJ, Turner LA. Toward a definition of mixed method research. J Mixed Methods Res 2007; 1 112–33.
| Toward a definition of mixed method research.Crossref | GoogleScholarGoogle Scholar |
[16] World Health Organization (WHO). Promoting mental health: concepts, emerging evidence, practice. A report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. Geneva: WHO; 2004.
[17] Pawson R, Tilley N. Realistic evaluation. London: Sage; 1997.
[18] Wand T, White K, Patching J. Contemporary mental health program implementation and evaluation. Issues Ment Health Nurs 2010; 31 716–22.
| Contemporary mental health program implementation and evaluation.Crossref | GoogleScholarGoogle Scholar | 20936893PubMed |
[19] Mental Health Council of Australia (MHCA). Not for service. Experiences of injustice and despair in mental health care in Australia. Canberra: MHCA; 2005.
[20] McGorry P. Truth and reality in early intervention. Aust NZ J Psychiatry 2012; 46 313–6.
| Truth and reality in early intervention.Crossref | GoogleScholarGoogle Scholar |
[21] Projects JA. External review of psychiatric emergency care centres in NSW. Final report to NSW Ministry of Health. Chatswood, NSW: Emergency Care Institute NSW; 2012. Available at: http://www.ecinsw.com.au/sites/default/files/field/file/PECC%20Review%20-%20FINAL%20REPORT%20endorsed%20by%20MHDAO.pdf [accessed 22 March 2013].
[22] Allen M, Forster P, Zealberg J, Currier G. Report and recommendations regarding psychiatric emergency services; a review and model program descriptions. Arlington: American Psychiatric Association Taskforce on Psychiatric Emergency Services; 2002.
[23] Wand T, White K, Patching J. Realistic evaluation of an emergency department based mental health nurse practitioner outpatient service in Australia. Nurs Health Sci 2011; 13 199–206.
| Realistic evaluation of an emergency department based mental health nurse practitioner outpatient service in Australia.Crossref | GoogleScholarGoogle Scholar | 21595814PubMed |
