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

Chapter 1
Introduction
1.1 Introduction.
Change involves altering the way things are done with the intention of improving
practices. This is particularly relevant to the Health Services which is in a constant of
transformation and reform. The Emergency Department (ED) is a prime example of this.
There is a continuous endeavour to improve the delivery of care and services to the public.
This process involves assessment, planning, implementation and evaluation to achieve the
quality of service required (Welford, 2006). All changes must have the patient as the central
focus of any initiative, and accordingly, in the context of this project, patient welfare was a
primary consideration in my decision to implement a change in the way ED staff triage those
who present for treatment. This project was undertaken in a busy ED in Dublin. The change
process was carried out in conjunction with the Health Service Executive (2008) Change
Model.
In this chapter I discuss the rationale for choosing this particular change management
project which addresses the triage and assessment of patients with Mental Illness in the ED.
The presentation of this group of patients attracts extensive debate within the department and
therefore I believed that I should devote my time to bringing about change to improve the
assessment and treatment of these patients. Chapter 2 relates to the Literature Review where I
consider mental illness and its prevalence in today’s society and the negative attitudes
towards mental illness. In the final section of the Literature Review I discuss the concept of
triage and its importance in the ED. I also examine the Mental Health Triage Tool devised in
Australia for use in the assessment of patients with Mental Illness.
Chapter 3 deals with Methods which involves a discussion of organisational culture
and considers its significance in the change process. A brief analysis of the chosen change
model (the Health Service Executive (2008) Change Model) and the rationale for its selection
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