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

Appendix J Project Impact Statement
Describe here how things are now in relation to the issue
Describe here how things should (ideally) be when the issue has been
addressed
Behavioural : describe current patterns of behaviour/ attitudes
of the key people involved with the issue
Patients presenting with Mental Illness to the Emergency
Department (ED) are triaged using the same format as patients
with a medical or surgical complaint.
ED nurses may have little or no formal education training in
Mental Illness.
No set computerised triage system in place to document
accurate and important details in relation to patient with mental
illness
Behavioural: what sort of behaviours would (ideally) be evident when
the issue has been addressed
Streamlining of patients with mental illness
Reviewed by clinical specialist in mental health in a timely fashion
Reduction in psychological distress for patient
Mental health nurse specialist in the ED.
Recording of accurate and relevant data on patients condition
Improved system of information gathering for audit purposes
Structural: describe the way roles and responsibilities are
currently organised
Triage nurse assesses patient with mental illness using
Manchester Triage System(MTS)
Patient generally returns to waiting room if deemed not to be in
crisis as per triage assessment
Emergency department clinician reviews patient
Decision to refer to psychiatry made following assessment
Decision made for admission/discharge
Structural: describe how roles/responsibilities would be organised once
this issue has been addressed
Assessment done using Mental Illness Triage Tool in conjunction with
MTS
Liaison psychiatry contacted as per triage category with reference to
Mental Illness Triage Tool direct from triage.
Review by liaison psychiatry.
If patient requires medical assessment review directly by medical team
not ED.
Decision made for admission/discharge.
Cultural: describe “how things are done around here” now,
e.g. accepted ways of doing things, implicit understanding
Assessed by triage nurse using MTS
Allocated triage category
Security informed if patient considered high risk
Patient returns to waiting room
Awaits ED clinician review
Decision made to refer patient to liaison psychiatry
Patient waits for psychiatry assessment
Cultural: what will be “the way things are done around here” when the
issue has been addressed
Assessed by triage nurse using Mental Illness Triage Tool in conjunction
with MTS
Appropriate triage category allocated
Security informed if patient considered high risk
Triage nurse liaises with liaison psychiatry
Appropriate nursing documentation completed including recording of
nurse assigned to take charge of patient.
Patient directed to ‘quiet’ room away from noisy waiting room for
review by liaison psychiatry
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