Currently we have 8 psychiatrists, and 9 nurses. Referrals come from GP's/NP's for medication review, diagnosis request, or consultation. Problem is that some doc's want to follow with client and have had clients since 2007!
Increase the time between appointments and slowly wean the patient off the appointments, and discharge the patient eventually. At discharge, reassure the patient and their GP that they can be referred in the future if any relapse in illness can not be sorted by the GP.
Also, check through the notes and see how many relapses the patient has had since 2007. If not many it means they need discharging. you could make up discharge rules eg
Discharge if less than one relapse a year and less than one change in medication in a year, etc.
see
Article Psychiatric Discharge Process
Remember that some patients need md follow up for many years. Suggest max staff skills utilization for assessments followed by a very short psych consult. Also introduce group therapies approaches. Consider introduction of some pathway or guidelines for schizophrenia. Bipolar . Use standardized assessment eg telesage..com. Provides accurate diagnosis for common conditions
I have seen usually non mds direct patient contact around 55 percent??????Your mds spent more due to payment methods.
Need to grow capacity of team. Try some middle grade health practitioners too. Plenty of clerical support for service efficiency
i think you could have nurses do initial assessments followed by brief psych consult.
(Problem is that some doc's want to follow with client and have had clients since 2007!)- i think you can get some volunteer's support for follow up ''''''
Follow up of patients by mds would be standard but introduction of peer support groups would relieve the burden off mds. They would only meet mds if their attached clinician feels that there is a need for the discharged ones.
If possible, all new cases are seen by mds, follow up by gps unless referred for consultation such as relapses.
Linda Taylor does your clinic have a clear Model of Care (MOC)? It may be worth starting with that as the MOC should guide your service as to the journey a patient should expect. Additional implementation guides can proved clearer structures such as expected interventions and timeframes of engagement that may be appropriate to different diagnostic groups (there will always be a few people that need longer - but by in large most people should be encouraged to engage a recovery plan and reduce reliance on a medical model). Perhaps your MD's could become familiar with the Recovery Model if they are not already. As for referring back to the GP/NP, consider making this arrangement a "co-share" one rather than your clinic "taking over" the care - the patient should remain a patient of the GP/NP, with your service as an additional, time-limited support.... All that can be clearly articulated in a good MOC, and be part of the agreement for your services. I hope this helps.
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