Fiona Stanley Hospital Emergency Department Diversion Clinical Psychology Service: An Evaluation of Improved Access to Care
Hyranthi Kavanagh1, SANDRA MCMILLAN1, Taylor Joachim2, Natalie Gasson21FSFHG DEPARTMENT OF CLINICAL PSYCHOLOGY & NEUROPSYCHOLOGY, MURDOCH, PERTH, WESTERN AUSTRALIA, AUSTRALIA2Curtin University School of Population Health, Curtin, Western Australia, Australia
Abstract
The Fiona Stanley Hospital (FSH) Emergency Department Diversion Clinical Psychology Service (EDDCP) and outpatient clinical psychology clinic (OPC) was set up to improve access to psychological care within a busy emergency department setting. This service embeds clinical psychologists in the ED to provide rapid assessment to patients presenting in crisis, diverting suitable patients to an OPC for specialised psychological treatment. Through point of care engagement with a clinical psychologist and redirection to accessible short-term psychological interventions, the EDDCP Service aims to (1) reduce patient wait time in ED (2) improve access to essential psychological therapies for patients who would benefit from timely interventions (3) evaluate clinical outcomes.
METHOD: The utilisation of the service was assessed in a sample of 381 patients (M=32.45 years old, 63.8% female). Patient outcomes and variables that predicted utilisation of the service were assessed using the Depression, Anxiety, and Stress Scale (DASS-21) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) in a
sample of 44 patients (M=28.41 years old, 63.6% female).
RESULTS: Results demonstrated a low median ED length of stay (2 hours and 49 minutes), high engagement (87.21%), low re-presentation rates (3.67%), and high satisfaction with the service (85.42%). A GLM repeated measures analysis
demonstrated a statistically significant (p <.001) 53.45% decrease in psychological distress and a 55.01% increase in quality of life in patients after discharge from the OPC. The magnitude of these effects was large (η2= .35 and .61). Hierarchical multiple regression showed that the number of
OPC sessions attended was the only significant (p <.05) predictor, accounting for 9% of DASS-21 change scores with a small effect size (R2= .09).
IMPLICATIONS: This evaluation highlights the effectiveness of the EDDCP service and OPC, with implications for the implementation of similar services in other emergency departments.
Biography
Hyranthi Kavanagh is a Consultant Clinical Psychologist and Head of Department, Clinical Psychology and Neuropsychology at Fiona Stanley Fremantle Hospital. Hyranthi has over 20 years’ experience in clinical practice and teaching in WA and NHS. The past 15 years has encompassed a variety of clinical and operational leadership roles within FSFHG, Royal Perth Hospital, and private practice. Areas of clinical expertise include working with adults with severe and enduring mental health problems and delivery of integrated psychological therapies within a medical context. She is a strong advocate for equitable and timely access to specialised psychological care within secondary/tertiary health care.