Improving the Assessment and Triage of Patients with Mental Illness ...

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4.2 Evaluation Tools and Outcomes of the Change. Evaluation of the change was analysed through both quantitative and qualitative approaches. These included pre and post implementation questionnaires (Appendix I and N) to probe for crucial information, focus group, interview and observational audit collection. The evaluation confirmed that: (a) nurses levels of confidence increased, (b) the time it takes to triage a patient as a result of the pop-up screen was reduced, (c) the triage tool helped to clarify the actions to be taken following triage (d) effective communication and stakeholder involvement ensures success of change initiatives. The questionnaires were circulated to 65 staff and constructed to measure pre and post the change management project. The pre-implementation questionnaire consisted of four questions: two questions reflect the level of experience and qualifications of staff in the ED, one question concerns the number of staff with a formal education in mental health and the final question pertains to confidence levels regarding the triage and assessment of patients with a mental illness. Two results from the questionnaires are represented by pie charts, Appendix O represents formal education in mental illness and Appendix P compares confidence levels pre and post implementation of the change management programme. There was a 79% response rate to the pre-implementation questionnaire and an 85% response to the post-implementation questionnaire. The difference accounted for staff returning off various leave. Pre-implementation results revealed that 66% of staff had no formal education in mental health, four staff had post graduate qualifications and three staff had a primary degree in mental health. It was also noted that of seven clinical nurse managers and two clinical facilitators none had a formal qualification in mental health. Levels of confidence in triage improved following implementation of the triage tool and computerised pop-up screen. Pre change shows level of low confidence at 35% but following the change project low levels of confidence reduced to 23%. Questionnaires and interviews conducted with the clinical nurse managers and clinical facilitators indicated that they had noted that there was significant improvement in the triage and assessment of patients with mental illness. 34
The observational audit carried out in triage pre the implementation noted that patients triaged using the Mental Illness Triage Tool were given a higher triage category (Appendix Q) than those triaged using the Manchester Triage Scale. Finally triage times were reduced from six minutes to four minutes. This reduction according to staff was related to the computerised pop-up screen While staff almost unanimously agreed that the computerised pop-up screen and the triage tool were of benefit to the department, the nursing assessment document was not greeted with the same level of enthusiasm. The design was not the issue; the fact was that nursing staff considered that there were too many nursing documents to manage. It was suggested that the design should be amalgamated with the original document. Despite not accomplishing all the elements outlined in the Project Impact statement it was considered that the change management project was ultimately a success. Those elements not achieved are currently being considered by management (such as the contacting of psychiatry direct from triage and the retention of a mental health nurse practitioner) and negotiations are in progress with the relevant authorities. 4.3 Conclusion The results of the questionnaires, focus group and interviews have provided considerable information on the benefits of the change project. Based on the findings it can be concluded that; the use of a well structured triage tool can benefit the assessment of the patient and significantly increase staff confidence by providing guidance in relation to the patient’s presentation. The development of a triage screen that requires only a “yes” or “no” response while still gathering significant information on the patient helps to cut down on triage times. These initiatives have led to improvements for patients and staff highlighting that although a project may be small it can have huge implications and benefits. The next chapter discusses the strengths and limitations of the project and also recommendations for the future. 35
Page 1 and 2: Royal College of Surgeons in Irelan
Page 3 and 4: Improving the Assessment and Triage
Page 5 and 6: Abstract Since the amalgamation of
Page 7 and 8: Table of Contents Abstract Acknowle
Page 9 and 10: Chapter 1 Introduction 1.1 Introduc
Page 11 and 12: However there are a large number of
Page 13 and 14: Chapter 2 The Literature Review 2.1
Page 15 and 16: with mental health issues, who pres
Page 17 and 18: Australia. The data was collected b
Page 19 and 20: Following implementation of the Nat
Page 21 and 22: Consequently the subsequent chapter
Page 23 and 24: must analyse their surroundings and
Page 25 and 26: After consideration of the aforemen
Page 27 and 28: questioning the patient about their
Page 29 and 30: The benefits of successful implemen
Page 31 and 32: Establishing trust was significant
Page 33 and 34: Group One: Nursing documentation- C
Page 35 and 36: Developing the implementation plan.
Page 37 and 38: Communication As discussed in relat
Page 39 and 40: Nevertheless as a change agent and
Page 41: crucial. The change agent or change
Page 45 and 46: Limitations arise as the project wa
Page 47 and 48: 5.5 Conclusion Improving the triage
Page 49 and 50: Cartwright, T., Baldwin, D. (2007)
Page 51 and 52: Happell, B., Summers, M., Pinikahan
Page 53 and 54: McAuliffe, E., Van Vaerenbergh, C.
Page 55 and 56: National Institute for Clinical Exc
Page 57 and 58: Wand, T. (2004) Mental Health Liais
Page 59 and 60: Appendices Appendix A Mental Illnes
Page 61 and 62: Appendix A Mental Illness Nursing A
Page 63 and 64: Appendix C Recommendations in World
Page 65 and 66: Appendix E Manchester Triage Algori
Page 67 and 68: Appendix G Health Service Executive
Page 69 and 70: Appendix I Change Management Projec
Page 71 and 72: Appendix K Mental Illness Triage To
Page 73 and 74: Appendix M Force Field Analysis Dri
Page 75 and 76: Appendix O Questionnaire results re
Page 77: Appendix Q 16 Triage Category alloc

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