Helen, this is an interesting question. However, there are several levels of staffing in closed psychiatric unit- psychiatrist, psychologist, social worker, mental health worker, etc. Discharge should retain team approach, and nurses alone do not carry liability for errors in deciding discharge. Timeliness is trumped by accuracy. 

Thanks Mary. I agree and I think the term Nurse Led Discharge is misleading. We would still be ensuring a full MDT approach to care planning, formulation, assessement and discharge planning. However, we are in a position where the geography and model we work with has built in delays which mean some service users discharge is delayed by the absence of a Consultant on the actual due day. The senior clinical leads in our service are nurses and so any pilot would initially be led by nurses. I mentioned timeliness and quality of discharge in reference to service user experiences of being delayed in hospital after they are well enough to leave. Accuracy and quality would actually be improved if we didn't have to rely on the physical presence of a Psychiatrist.

Hello All

I would like to share my experiences plus my hobby in AI as an engineer of knowledge base. In the UK I had a pure experience to be an in-patient consultant when NWW (New Ways of Working system) was implemented. To be honest with you, I think that during last 7 years was fully used system (Nurse Led Crisis Team System).

However admission to hospital always was finished by a doctor.

There should be also written responsibility of In-patient Consultant over the care within in-patient or home treatment setting. Therefore the rest is your confidence in experience of your colleagues and when the patient is not treated under MHA shouldn't be a problem

Let me talk about risk, generally higher, additionally acute mental health professionals usually focus on risk at the time of assessment only and they struggle with longitudinal assessment of risk and needs  and artificial intelligence such as PBR system, the cluster is very often wrongly coded and later corrected in community by person named a CCO. 

Hi Krysztof,

Thanks for your response. I fully agree the Consultant will need to be on board with any discharge plans from the beginning. However, I hope the shared responsibility will help other members of the MDT develop a better understanding of risk and of the need to be accurate in their assessment, clustering and coding in order for care packages to be fully effective.

How receptive were the Consultants to Nurse Led Discharge? I think the success of such inititaives is trust between professionals within the MDT and I wonder if work needs to be done in this area first to facilitate a successful outome?

Hi,

This is an interesting question, Doctors take decision for discharge, but that will be supported by the Nurse. I have done a discharge protocol for staff nurses during discharge, which shows the discharge programe was so effective, but the decision was taken by the consultant.