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Improving mental healthcare for emergency department frequent attenders

The Starling Collaborative brings together emergency department (ED) teams in the Thames Valley to improve mental healthcare for people who attend EDs on a frequent basis.

Its focus is on sharing best practice, better understanding patient flow and designing shared strategies based on collective knowledge and peer support. The Starling Collaborative is coordinated by the Oxford Academic Health Science Network Patient Safety Collaborative. It has two main goals:

  1. Sharing frequent attenders programme models across the Thames Valley region aiming to identify and implement best practice
  2. Using existing data our project will be able to categorise groups of frequent attenders (e.g. based on presenting complaints) and evaluate the outcomes of specific interventions. We hope to identify which frequent attenders are more receptive to particular interventions, allowing trusts to work together in optimising their efforts of influencing patient flow into the emergency department.

The initiative is scheduled to run for a year from October 2018-October 2019.

Initial work involves contacting trusts and other organisations to find out more about local models for meeting the mental healthcare needs of frequent attenders in ED and obtain views on the project. Other priorities include undertaking a literature review and finding out about other models in place across the NHS.

Early work includes:

  • developing with service users a co-designed bio-psycho-social assessment form to help standardise the way we understand some of the most complex patients
  • analysis of pseudonymised data sets to assess the extent to which patients may be frequently attending several EDs in the Thames Valley, allowing teams to collaboratively discuss strategies as well as seeking to understand how this is meeting service users’ needs.

We also plan to categorise and analyse already-collected anonymised detailed datasets within EDs and  use clinical knowledge and experience to determine which interventions produce the best outcomes, helping us design interventions to best help these service users.

Further analysis of pseudonymised datasets will allow organisations across the Thames Valley to see how patterns of use of services differ between areas, identifying unwarranted variation and allowing services to improve.

We propose to hold two workshops with partner organisations to share knowledge and ideas and inform developing improvement in local services. The workshops will cover:

  • sharing best practice from within and outside the Thames Valley
  • reviewing research findings from a literature review
  • exploring what data is telling us about frequently attending patients including where there may be unwarranted variation within our region
  • sharing methods from elsewhere to explore how organisations work together in each locality to provide services for ED frequent attenders.

Why is the project called the ‘Starling Collaborative’?

The Thames Valley Starling Collaborative takes its name from the flawless murmurations of starlings. To provide care effectively for frequent attenders requires coordinated awareness and effective relationships between a large number of stakeholders.

  • Read about the existing frequent attender programme in Oxfordshire here
  • The regional collaboration is supported by the Health Foundation’s Q Exchange programme

Further information:

  • Dr Deon Louw, Locum Consultant in Emergency Medicine, Emergency Department Lead for Mental Health, Oxford University Hospitals NHS Foundation Trust deon.louw@ouh.nhs.uk
  • Fran Butler, Programme Lead for Mental Health, Oxford AHSN fran.butler@oxfordahsn.org
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