Adams Alexander, Perry Jennifer, Young Stephanie
Lewisham Enhanced Recovery Service, South London and Maudsley NHS Foundation Trust, London, UK
Lewisham Enhanced Recovery Service, South London and Maudsley NHS Foundation Trust, London, UK.
BMJ Open Qual. 2020 Feb;9(1). doi: 10.1136/bmjoq-2019-000659.
A zoning system is used to ensure that service users receive appropriate levels of support while they are using community mental health team (CMHT) services. Patients are split into red, amber and green zones and are discussed in a daily morning meeting to ensure management plans are in place. We identified that the meeting was an area for improvement as initial feedback indicated that the meeting was repetitive, newcomers to the team found that they did not understand why patients were in different zones and discussions were not being documented. Our three aims for the project were to improve staff-rated satisfaction by 25%, to improve weekly documentation of discussions to 100% and to improve the quality of information handed over by 25% over 4 months.
We used the Model for Improvement and "plan, do, study, act" (PDSA) cycles to test change ideas such as having someone chair the meeting, use of a 'situation, background, assessment, recommendation, decision' (SBARD) format to handover, introduction of a blue zone for inpatients and documentation in a specific part of the electronic notes at a specific time.
We did not find our PDSA cycles led to a consistent change in satisfaction, quality and efficiency. We found an improvement of SBARD use up to 100% although this was not always consistent and an improvement in documentation to 100% for 3 weeks however this was not sustained.
On examining barriers to change, we found the key to sustaining improvement is in ensuring multidisciplinary team member involvement at all stages of the Quality Improvement project.
分区系统用于确保服务使用者在使用社区精神卫生团队（CMHT）服务时能获得适当水平的支持。患者被分为红区、黄区和绿区，并在每日晨会中进行讨论，以确保管理计划落实到位。我们发现该会议存在可改进之处，因为初步反馈表明会议内容重复，团队新成员不理解患者为何处于不同区域，且讨论未作记录。我们为该项目设定的三个目标是，在4个月内将员工评定的满意度提高25%，将每周讨论记录提高到100%，并将交接信息的质量提高25%。
我们使用改进模型和“计划、执行、研究、行动”（PDSA）循环来测试变革想法，比如安排专人主持会议、采用“情况、背景、评估、建议、决策”（SBARD）格式进行交接、为住院患者引入蓝区以及在特定时间在电子病历的特定部分进行记录。
我们发现PDSA循环并未使满意度、质量和效率产生持续变化。我们发现SBARD的使用率提高到了100%，尽管并非始终保持一致，且有3周时间记录工作达到了100%，但未持续下去。
在审视变革的障碍时，我们发现持续改进的关键在于确保多学科团队成员参与质量改进项目的各个阶段。
