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PROactive Management of Integrated

Services & Environments


333 Acute Care Pathways (Download PDF)

Manaan Kar Ray, Zahoor Syed

A radical redesign of mental health acute care was implemented in October 2011 in Peterborough and following its success an improved version was rolled out in Cambridge in May 2013. Traditional ward based care was replaced by functionalized time limited pathways focused on assessment and specific interventions.  

The Crisis Resolution and Home Treatment Team provided the foundation for the following inpatient pathways:

3 day assessment

3 week treatment

3 month recovery

The Crisis Resolution and Home Treatment Teams provides the foundation for these pathways. Each pathway has its specific role but they are all unified in there recovery oriented approach. Success depends on ensuring that people who present to acute care leave with a renewed sense of hope and self-determination that could add meaning and purpose to their lives and help them to better manage their life circumstances and mental health challenges. The focused approach on recovery has reduced lengths of stay and ensured that any stay on any ward is meaningful and adds value; 'quality up, costs down'. The bed capacity that has been created has made the acute care service more responsive resulting in earlier intervention, decreasing suffering and improving outcomes.

The evaluation of these pathways has showed consistent high scores on all the quality metrics (integrated assessment tool, respect-enablement-value scores, patient experience survey scores). Interestingly even on readmission rates they have outperformed the traditional locality based wards which had much longer periods of stay.

The principles which underpin the model are

- Every pathway will subscribe to the recovery principles:

o Finding and maintaining hope

o Re-establishment of a positive identity

o Building a meaningful life

o Taking responsibility and control

- Staff and patients working in partnership will set up realistic but challenging milestones towards which they will work together and hold themselves to account against them.

- Patients do not fit into pathways, but the pathways fit around the patient. i.e. time scales are indicative and not absolute and clinical judgement and common sense will over rule any archetypal protocol.

- Deliver seamless service experience for our patients and carers while eradicating wasteful double and triple assessment.

- Regular scrutiny of how a particular intervention is adding value to an individual patient on a particular pathway in comparison to other alternatives that are available in the same or other pathways.

- A risk balance sheet approach to risk management, i.e. when a risk is identified, a practitioner works out in a collaborative fashion with the patient and carer what reasonable steps can be taken within the resources available to manage the risks and what would be the least restrictive and most appropriate environment to manage the unaddressed but identified risk.

- Matching staff according to their skill set and interest to the pathway and then investment in further development so that they are trained to take a recovery oriented approach on all the pathways.

The following teams make up the Adult Acute Care Services

o Cambridge

Mulberry 1 (3 day assessment unit)

Mulberry 2 (3 week treatment unit)

Mulberry 3 (3 month recovery unit)

Crisis Resolution Home Treatment Team (North)

Crisis Resolution Home Treatment Team (South)

Springbank Ward (Personality Disorder Unit)

o Peterborough

Oak 3 (3 day assessment unit)

Oak 1 (3 week female treatment unit)

Oak 2 (3 week male treatment unit)

Oak 4 (3 month recovery unit)

Poplar (Psychiatric Intensive Care Unit)

Crisis Resolution Home Treatment Team (Peterborough & Fenland)

Crisis Resolution Home Treatment Team (Huntingdon)