Review of Activity Within Unscheduled Care at Royal Cornhill Post-Pandemic

Abstract

Aims

We sought to review the changes in assessments within the Unscheduled Care Team (UCT) at Royal Cornhill in Aberdeen since the pandemic. Previous UCT data highlighted an increase in monthly assessments from October 2018 to October 2020 by 18% 240(204). We hoped to identify areas for intervention and reform within the UCT and the wider service.

Methods

An excel spreadsheet was distributed to clinicians on-call from 1st–31st October 2021 and 1st-31st October 2022. Data analysed included time of referral, the role of the clinician, source of referral (Enhanced Access, Acute medical admissions/A&E, Other Hospital Wards, Community Mental Health Teams (CMHT), Police, GP, GMEDS (out-of-hours GPs), and Other Sources), method of assessment, time taken to complete assessments, time taken to discuss assessments and assessment outcomes. The spreadsheet also had space for clinicians to provide additional qualitative data. Following the 2021 data collection, a PowerPoint presentation was given to members of staff with the initial findings from 2021. The UCT added additional practitioners to the twilight period 1700-2100 due to the noted increased demand during this period. They also spoke to CMHTs about Enhanced Access and to the Police directly, as they were the two most frequent referrers. Following the 2022 data collection, the 2021 and 2022 datasets were compared.

Results

The overall number of assessments increased by 10% from 2021 to 2022 - 405(367). Additionally, total assessment time increased by 15% - 299(261) hours. In terms of assessment outcomes, the largest changes were seen in outpatient follow-up with CMHTs, with a 65% increase 238(144); UCT discharge, with a 43% decrease 64(112) and non-specified outcomes, with a 52% decrease 14(24). The largest changes in referral rates were from GMEDs 48(30) 60% increase, CMHTs 4(16) 75% decrease, GP 50(34) 47% increase. Enhanced access 96(95) and police referrals 78(77) remained the most stable, increasing by 1%.

Conclusion

There has been an evident increase in workload for the UCT since the pandemic, which could be managed with additional staffing for the team. The targeted interventions, both for Enhanced access and Police, have limited the increase of their referral rate. Similar targeted interventions and review of referral criteria may mitigate increased demand from other sources. Increasing outpatient CMHT follow-up after assessment may suggest that routine outpatient work may not be back to pre-pandemic levels; further study would be required to confirm this.