Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-25T08:45:40.540Z Has data issue: false hasContentIssue false
  • English
  • Français

Internal audit of attendances at a psychiatry outpatient clinic

Published online by Cambridge University Press:  13 June 2014

Brendan D Kelly
Brendan D Kelly*
Affiliation:
Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland
*
*Correspondence Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective: This audit aimed to (a) systematically identify problems related to rates of attendance and non-attendance at one psychiatry outpatient clinic; (b) quantify these problems; (c) implement strategies to improve service delivery; and (d) re-audit after three months.

Methods: Specific standards were set in relation to patterns of attendance at the outpatient clinic. Audit was performed over two weeks; changes to practice were agreed and implemented for three months; re-audit was performed.

Results: The initial audit showed that (a) 93 people attended the clinic over two mornings with a non-attendance rate of 13.9%; (b) 30.1% of individuals who attended did not have an appointment; (c) 20.4% of attendances were ‘inappropriate’; (d) 2.2% did not live in the clinic's catchment area. Based on these results, the clinic introduced a protocol for individuals who attended without appointment; a protocol for streamlining the provision of prescriptions; and a renewed emphasis on transferring the care of individuals not residing in the catchment area. Three months later, re-audit showed that (a) the number attending over two mornings decreased from 93 to 43, but the non-attendance rate had not changed; (b) the proportion of individuals presenting without an appointment (9.3%) decreased significantly compared to the initial audit (30.1 %); (c) the proportion of ‘inappropriate’ attendances (9.3%) tended to decrease compared to the initial audit (20.4%) but this was not statistically significant; (d) there was no difference in the proportion of patients who did not live in the catchment area; these proportions were low in both the initial audit (2.2%) and re-audit (2.3%).

Conclusions: A relatively simple audit such as this can result in a more efficient and appropriate delivery of outpatient mental health services. On this basis, there is a need to provide ongoing resources for further cycles of clinical audit in mental health services.

Keywords

OutpatientMental healthAuditResourcesAttendance.
Type
Audit
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 4 , December 2008 , pp. 136 - 140
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Department of Health and Social Security. Royal Commission On The Law Relating To Mental Illness And Mental Deficiency. Cmnd 169. HMSO, London, 1957.Google Scholar
2.Dyer, JAT. Rehabilitation and Community Care. In: Kendell, RE, Zealley, AK (Eds.) Companion of Psychiatric Studies (5th ed). Churchill Livingstone, Edinburgh, 1996.Google Scholar
3.Department of Health. The Psychiatric Services – Planning For The Future. The Stationery Office, Dublin, 1984.Google Scholar
4.Kelly, BD. Mental health policy in Ireland, 1984-2004: theory, overview and future directions. Ir J Psychological Med 2004; 21: 61–68.CrossRefGoogle ScholarPubMed
5.Expert Group on Mental Health Policy. A Vision for Change: Report of the Expert Group on Mental Health Policy. The Stationery Office, Dublin, 2006.Google Scholar
6.Walsh, D, Daly, A. Mental Illness in Ireland, 1750-2002: Reflections on the Rise and Fall of Institutional Care. Health Research Board, Dublin, 2004.Google Scholar
7.Daly, A, Walsh, D. Irish Psychiatric Services: Activities 2002. The Health Research Board, Dublin, 2003.Google Scholar
8.Department of Health and Children. Guidelines on Good Practice and Quality Assurance in Mental Health Services. The Stationery Office, Dublin, 1998.Google Scholar
9.Inspector of Mental Health Services. Report of the Inspector of Mental Health Services. The Stationery Office, Dublin, 2005.Google Scholar
10.Fadden, G, Bebbington, P, Kuipers, L. The burden of care: the impact of functional psychiatric illness on the patient's family. Brit J Psychiatry 1987; 150: 285–292.CrossRefGoogle ScholarPubMed
11.Mollica, RF. From asylum to community. The threatened disintegration of public psychiatry. NEJM 1983; 308: 367–373.CrossRefGoogle ScholarPubMed
12.Olfson, M, Klerman, GL, Pincus, HA. The roles of psychiatrists in organized outpatient mental health settings. Am J Psychiatry 1993; 150: 625–631.Google ScholarPubMed
13.Inspector of Mental Hospitals. Report of the Inspector of Mental Hospitals for the year ending 31 st December 2001. The Stationery Office, Dublin, 2002.Google Scholar
14.Inspector of Mental Hospitals. Report of the Inspector of Mental Hospitals for the year ending 31 st December 2003. The Stationery Office, Dublin, 2004.Google Scholar
15.O'Keane, V, Jeffers, A, Moloney, E, Barry, S. Irish Psychiatric Association survey of psychiatric services in Ireland. Psychiatric Bull 2004; 28: 364–367.CrossRefGoogle Scholar
16.O'Neill, C, Sinclair, H, Kelly, A, Kennedy, H. Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes? Ir J Psychol Med 2002; 19: 48–54.CrossRefGoogle ScholarPubMed
17.Lelliott, P. Making medical audit effective. Specialty supplement: psychiatry. Joint Centre for Education in Medicine/Research Unit of the Royal College of Psychiatrists, London, 1993.Google Scholar
18.National Health Service, National Institute for Clinical Excellence, Commission for Health Improvement, Royal College of Nursing and University of Leicester. Principles for best practice in clinical audit. Radcliffe Medical Press, Oxon, United Kingdom, 2002.Google Scholar
19.Department of Health and Children. Quality and Fairness: A Health System for You. The Stationery Office, Dublin, 2001.Google Scholar
20.Royal College of Psychiatrists. Good Psychiatric Practice. Royal College of Psychiatrists, London, 2004.Google Scholar
21.SPSS Inc. SPSS 12.0 Base Users Guide. Prentice-Hall Regents, Upper Saddle River, New Jersey, 2003.Google Scholar
22.James, A, Kendall, T, Worrall, A. Clinical Governance in Mental Health and Learning Disability Services: A Practical Guide. Gaskell, London, 2005.Google Scholar