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      Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

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          Abstract

          Background

          Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.

          Methods

          Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a four-stage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.

          Results

          Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency ‘Discharge Team’ (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.

          Conclusion

          This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and information flow. A pilot of the proposed intervention is now needed to test the feasibility and effectiveness in reducing adverse outcomes.

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          Most cited references31

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          Excess Mortality, Causes of Death and Life Expectancy in 270,770 Patients with Recent Onset of Mental Disorders in Denmark, Finland and Sweden

          Background Excess mortality among patients with severe mental disorders has not previously been investigated in detail in large complete national populations. Objective To investigate the excess mortality in different diagnostic categories due to suicide and other external causes of death, and due to specific causes in connection with diseases and medical conditions. Methods In longitudinal national psychiatric case registers from Denmark, Finland, and Sweden, a cohort of 270,770 recent-onset patients, who at least once during the period 2000 to 2006 were admitted due to a psychiatric disorder, were followed until death or the end of 2006. They were followed for 912,279 person years, and 28,088 deaths were analyzed. Life expectancy and standardized cause-specific mortality rates were estimated in each diagnostic group in all three countries. Results The life expectancy was generally approximately 15 years shorter for women and 20 years shorter for men, compared to the general population. Mortality due to diseases and medical conditions was increased two- to three-fold, while excess mortality from external causes ranged from three- to 77-fold. Mortality due to diseases and medical conditions was generally lowest in patients with affective disorders and highest in patients with substance abuse and personality disorders, while mortality due to suicide was highest in patients with affective disorders and personality disorders, and mortality due to other external causes was highest in patients with substance abuse. Conclusions These alarming figures call for action in order to prevent the high mortality.
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            Complexity science: Complexity, leadership, and management in healthcare organisations

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              Balancing "no blame" with accountability in patient safety.

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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                21 April 2020
                2020
                : 11
                : 328
                Affiliations
                [1] 1NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester , Manchester, United Kingdom
                [2] 2School of Health Sciences, University of Nottingham , Nottingham, United Kingdom
                [3] 3NHS Derbyshire Healthcare Foundation Trust , Derby, United Kingdom
                [4] 4NIHR School for Primary Care Research, Manchester Academic Health Science Centre, School for Health Sciences, University of Manchester , Manchester, United Kingdom
                [5] 5Health Services Management Centre, University of Birmingham , Birmingham, United Kingdom
                Author notes

                Edited by: Eric D. Caine, University of Rochester, United States

                Reviewed by: Justin Newton Scanlan, University of Sydney, Australia; Ruth Baxter, Bradford Institute for Health Research, United Kingdom

                *Correspondence: Natasha Tyler, natasha.tyler@ 123456manchester.ac.uk

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2020.00328
                7186904
                32372990
                ff8eaa45-0df7-4c30-8e70-56d96c25b58f
                Copyright © 2020 Tyler, Wright, Grundy, Gregoriou, Campbell and Waring

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 October 2019
                : 01 April 2020
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 43, Pages: 12, Words: 7430
                Funding
                Funded by: NIHR Greater Manchester Patient Safety Translational Research Centre 10.13039/501100013235
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                nominal group technique,mental health,discharge,care transitions,adverse outcomes,psychiatric discharge,intervention,information sharing

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