Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis

Abstract

Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a 'parity of esteem' between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team's performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.

Keywords: audit and feedback; control charts/run charts; management; mental health; quality improvement.

Figure 1

Local referral-to-treatment pathway for those experiencing First Episode Psychosis based on National Health Service (NHS) England guidelines. ABIT, Access and Assessment and Brief Intervention; CPA, Care Programme Approach; EIP, Early Intervention in Psychosis; GP, general practitioner; HTT, home treatment team; NELFT, North-East London NHS Foundation Trust; TeamCCO, care co-ordinator.

Figure 2

Statistical process control (SPC) chart showing the time between the date of referral and the first appointment with Thorpe Coombe Hospital EIP. DNA’d, did not attend; EIP, Early Intervention in Psychosis.