To achieve 90% of ward referrals to MHLS having adequate information provided on online referral system. To improve ward staff knowledge and confidence through education in order to empower them with ability to make appropriate and timely referrals.

Quality Improvement Project established at start of 2022 after discussion with MHLS with regards to referrals. MHLS acts at interface with acute medical wards and there were operational issues identified that could be improved. Driver diagram used to map these, to establish where intervention could be most effective. Lack of detailed referral often requires phone-call to the ward to seek further information, delaying patients’ assessment.

Criteria to be included on referral defined as: reason for referral, reason for admission, investigations performed, past psychiatric history, medications prescribed, and substance use history.

Two Plan Do Study Act (PDSA) cycles were established, the first in February 2022 that involved targeted lunchtime teaching of F1 doctors who are new to making referrals and may lack confidence.

Second PDSA cycle was established from December 2022 to January 2023 and focused on nursing staff as it was predominantly this cohort referring. A poster campaign on good practice and preferred information to be included in referrals was established on acute wards and discussed at nursing safety briefs. Data were then reanalysed.

We subsequently acquired data regarding wards which made the highest number of referrals and were able to specifically target the top ten as a third intervention. Further data collected end of January 2023.

Reason for referral inclusion improved (95.07% to 96.43%). Reason for admission to hospital similarly (92.56% to 100%). Past Psychiatric History inclusion improved (14.88% to 27.91%). There was an improvement in inclusion of prescribed medication (16.53% to 42.86%). Relevant investigations being included improved (9.92% to 17.86%) and substance abuse history improved (16.53% to 42.86%).

Overall number of referrals from same time period the previous year reduced from 349 to 307 post-interventions.

Whilst some clear improvements have been noted, there are still significant barriers towards the relevant referral content being included.

However, from speaking to ward staff there is evidence that thinking has improved in terms of appropriateness of referral, supported by reduction in referral numbers. This is possibly an impact of visual poster prompts, teaching and face to face discussion with staff.

Further work to help sustain improvement could include questionnaires distributed to wards, input at medical changeovers and prompting document circulated via email to all Trust staff.