St. Vincent's Psychiatric Emergency Care Centre: an Evaluation of a Nurse-Led Service
Australia, like many other countries that adopted deinstitutionalisation is experiencing increased presentation at emergency departments (EDs) by patients with acute mental health and addiction needs. While different models of psychiatric emergency care have been utilised within EDs little is known about the effectiveness of the care provided or how they work on a day-to-day basis. Psychiatric Emergency Care Centres (PECCs) is one of these new initiatives. PECCs aim to improve patient flow in urban EDs by providing a rapid pathway to specialist mental health assessment and care. St Vincent hospital in Sydney opened a 6 bed PECC service in 2005. It is co-located with ED and staffed 24 hours a day by registered mental health nurses supported by psychiatric and emergency teams. The service has two components - a short term stay unit and an ED liaison role. The nurses work closely with community mental health teams, inpatient units, general practitioners, non-government agencies and other hospitals. This thesis evaluated the organisational and operational aspects of this PECC service using a processimpact evaluation. Documents, existing clinical records and interviews with nurses in the PECC and ED and with a consumer representative were used as data sources to describe the service and identify what was working well and what could be improved. The research found that the service has provided additional resources and collaboration between ED and mental health services. In addition the research found that PECC is an effective service catering to the needs of consumers and providing access to mental health specialist clinicians. Since PECC was established there has been an increase in assessments conducted within the ED and an increase in the numbers presenting to ED for mental health reasons from 2833 in 2006 to 4987 in 2008, but the number of admissions to PECC have remained relatively stable at 693 and 714. Aspects of the service that worked well included the rapid assessment and management of acutely unwell people by the PECC nurses. Aspects that were problematic concerned the ability of the service to address social issues and the management of people with behavioural, alcohol, substance intoxication or selfharm behaviours. Areas for enhancing the service include being more consumers responsive, increasing the skills and knowledge of staff and undertaking further research regarding the needs of people who use the service.