Clemente Carmen, McGrath Rita, Stevenson Clare, Barnes Jacqueline
Royal Free Hospital, Pond Street, London NW3 2QG, UK. E-mail:
Enfield Child Guidance Service, 8 Dryden Road, London EN1 2PP, UK.
Child Adolesc Ment Health. 2006 May;11(2):98-103. doi: 10.1111/j.1475-3588.2005.00386.x.
The aim of the study was to evaluate Initial Assessment (IA), a new system for managing referrals. The system is designed to: reduce waiting times, reduce 'did not attend' (DNA) rates, and improve multi-disciplinary team working and team morale, compared to the existing referral procedure.
A comparison was made between a child mental health service using IA and a second centre using the existing system over a 6-month period, based on administrative records, a child functioning measure, staff and user questionnaires.
The Initial Assessment system was associated with a significantly shorter average waiting time for the first appointment (9 weeks) and a lower DNA rate (10%) in the intervention centre. The populations seen under the new and existing systems were similar in terms of the severity of cases. Staff reported a positive impact overall on team working and team morale, despite a reported individual increase in time pressure; users reported acceptance of the system.
Findings suggest that the increase in team morale and support from colleagues associated with the new system may have mediated against any negative impact of the increased time pressure. Substantial cost savings to the NHS are indicated.
本研究旨在评估一种新的转诊管理系统——初始评估（IA）。与现有转诊程序相比，该系统旨在：缩短等待时间，降低“未就诊”（DNA）率，改善多学科团队协作及团队士气。
基于行政记录、儿童功能测评、员工及用户问卷，对一个使用IA的儿童心理健康服务中心和另一个使用现有系统的中心在6个月期间进行了比较。
在干预中心，初始评估系统与首次预约的平均等待时间显著缩短（9周）以及较低的DNA率（10%）相关。新系统和现有系统下所诊治的人群在病例严重程度方面相似。员工报告称，尽管个人感觉时间压力有所增加，但总体上对团队协作和团队士气有积极影响；用户报告称接受该系统。
研究结果表明，与新系统相关的团队士气提升及同事间的支持可能抵消了时间压力增加带来的任何负面影响。这表明国民保健制度（NHS）可大幅节省成本。
