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Documenting the pre-implementation phase for a multi-site translational research project to test a new model
Timothy Wand1, Christina Crawford2, Nerida Bell3
1Sydney Nursing School, University of Sydney and Sydney Local Health District, Emergency Department, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia.
Background:
Presentation rates to Emergency Departments (ED) for people with mental health, drug health and behavioural problems are increasing. This necessitates a reorientation of health services and resources to meet this change in demand.
Aims:
This multi-site translation research project aims to implement and evaluate an innovative model of mental health nursing care in three EDs across New South Wales (NSW) Australia.
Methods:
Three EDs (one city, regional, and rural site) were selected to participate in the project. A qualitative mixed methods approach was used in the pre-implementation phase comprising clinician focus groups (n = 3) and face-to-face interviews with senior staff (n = 15). A planning day and site visits were conducted involving consultation with key clinical, management and executive staff.
Findings:
Timeliness of consultations, lengthy assessment and documentation processes and delays in decisions regarding patient disposition were the main frustrations expressed by ED staff and hospital executives. A designated team of mental health nurses based in the ED to see patients from the point of triage was viewed favourably for supporting the therapeutic care of people with mental health, drug health and behavioural problems. However, several psychiatrists raised objections over the clinical governance of the team culminating in one site leaving the project.
Conclusion:
Implementing new models of care that require a change in thinking and practice can challenge power relations which subsequently impact on individual willingness to support proposed change. Therefore, even with demonstrated effectiveness, extensive consultation and high level support the cooperation of key local stakeholders is not always assured.
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