Early Intervention in Psychosis service has measure of data challenge

A digital dashboard showing daily updates of progress against the new access and waiting time standard for early intervention in psychosis is helping improve outcomes in Berkshire.

The tool was created at Berkshire Healthcare NHS Foundation Trust so clinicians could make sure people receive the early help they need and to evaluate performance against each National Institute for Health and Care Excellence (NICE) recommended intervention for Early Interventional in Psychosis (EIP).

The standard, which came into force on 1 April, requires more than 50 per cent of people experiencing a first episode of psychosis to begin a NICE-recommended package of care within two weeks of referral. That includes:

  • Cognitive behavioural therapy for psychosis
  • Family interventions
  • Prescribing antipsychotics, if clinically indicated
  • Education and employment support
  • Physical health assessments
  • Wellbeing support; and
  • Carer/family focused education and support

In June and July 2016 the Berkshire service saw 100 per cent of its referrals within the required timeframe, up from 89 in May and 88 per cent in April.

NICE interventions are offered to everyone at the outset and the service is working to ensure these are offered at timely intervals throughout the three-year treatment period because patients vary in their readiness to engage with interventions, such as cognitive behavioural therapy for psychosis and Individual Placement and Support (IPS).

The dashboard, which links into the trust’s electronic health record system, was created last year when EIP Service Manager Zoe Emms asked the trust’s clinical transformation team for help in generating the data needed to develop the service.

“In 2014, I’d been asked to do an audit of how we were doing as a trust in terms of preparedness for the implementation of the new standards,” she said. “The only way to do this was by a manual audit of every case and it took forever, which was not something I wanted to repeat.

“The common assessment tool had been developed and at that point I knew we were able to do more in Rio than we had previously. I started thinking how were we going to collect the information to provide both quantitative and qualitative data related to the standards and the patient journey and outcomes.

“We started with the RTT pathway, which made it easier to look at whether we’d met the access waiting time and use the information from any breaches to target the areas that required support.”

The dashboard now provides caseload figures, referral to treatment time, including information on those still waiting and breaches, and shows performance against the NICE interventions. It also allows clinicians to look at each individual’s progress through the service and for team leaders to monitor service compliance and any deficits.

A medicines pathway has recently been added, allowing the service’s pharmacist to identify and monitor compliance with medication prescribing guidelines.  Work is also underway to incorporate a new electronic template based on the Lester Tool for physical health checks.

“The Lester Tool is very comprehensive and recording of physical health checks had previously caused confusion,” Mrs Emms said. “The new electronic template has been developed to give guidance to clinicians when entering data from the checks which will then point them to the required intervention.

“What we didn’t want is for a person to see that someone might have high blood pressure but then not to take any action. The information from the checks will then be pulled through onto an editable letter for GPs.”

The dashboard is refreshed each morning, which means up-to-date information is available to discuss during staff meetings attended by the multidisciplinary team who include a pharmacist, psychologists, IPS workers, social workers, occupational therapists, community psychiatric nurses and other care co-ordinators.

It has allowed the service not only to improve individual patient management but to also look more broadly at how it operates, comparing patient journeys to identify whether processes and relationships with other teams can be managed more effectively.

This, for example, has resulted in an EIP champion in the crisis service who now works with their own and the six EIP locality teams to ensure patients experiencing a possible first episode of psychosis are referred on as quickly as possible. It followed an analysis of RTT data which highlighted instances where this needed improvement.

Mrs Emms added: “The dashboard is really helpful, but it’s a work in progress and will require ongoing review.  The great thing is that the information required is not just one person’s responsibility. All clinicians involved in the individual’s care, whether that be a psychologist or an IPS worker, are able to update the form to provide information about the interventions provided.

“Going forward it’s vital that we are able to evidence that we are a sustainable service  The data we are now able to provide will allow us to both show our compliance with the standards and to see what positive differences we’ve made to people’s lives.

“It’s good for clinicians to see what difference has been made, and it’s good for morale. Last month we hit 100 per cent in RTT and to be able to see that on the screen is great.

Tim Kendall, NHS England’s National Clinical Director for Mental Health, said: “It’s essential local services understand how to measure performance and outcomes in order to obtain the data they need to deliver and demonstrate sustainable improvements in care.

“Berkshire’s dashboard shows they’ve got the measure of this data challenge. It allows them not only to assess local performance against national standards but also to identify any problems in how they operate as a service, and how they can work with colleagues to put that right.”