Improving the Physical Health Monitoring of City & Hackney Assertive Outreach Service Patients

Improving physical healthcare to reduce premature mortality in people with SMI (Serious Mental Illness) is a priority for ELFT (East London NHS Foundation Trust) and NHS England. It is well know that people with schizophrenia have a life expectancy which is approximately 20% shorter than that of the general population and a substantial mortality difference exists between people with schizophrenia and the general community.[1-2] Among other risk factors, such as poor diet, physical inactivity, and high rates of smoking, the iatrogenic effects of anti-psychotic medications have been found to increase the risk of metabolic syndrome. This can easily be detected through regular monitoring. Through this project, it was our aim to improve the physical health monitoring of City & Hackney Assertive Outreach Service (AOS) patients with a view to decrease mortality rate, increase life expectancy, increase the quality of life, and reduce harm from medication. This was done using quality improvement methods, including several change ideas, each of which started sequentially over the course of a nine month period from November 2014. Following QI methodology, this utilised cycles of iterative learning using PDSA methods and was supported by the Trust's extensive programme of quality improvement, including training provided by the Institute for Healthcare Improvement. The project involved setting a specific aim which was improving the physical health monitoring of AOS patients to 80% by July 2015 and for our patients to have physical health checks (blood tests, weight, ECG, BP) as a minimum annually. From baseline measurements of between 50-75%, we reached our target of 80% for weight, BP and blood tests monitoring, with 89%, 91%, and 84% achieved respectively by July 2015. Further progress still needs to be made on ECGs, with 77% achieved by July 2015, although the monitoring of ECG nearly doubled from 39% in November 2014 to 77% in July 2015. This project demonstrated that effective leadership, collaborative team work, embedding the project in our daily practice, generating local solutions, and improved communication between primary and secondary care can increase the physical health monitoring of this complex and challenging patient group. The team continues to identify other areas for change that may lead to further improvement in the physical health monitoring of AOS patients while making sure that the improvement is sustained.