Readmissions to acute specialised mental health inpatient services within 28 days of discharge

Rationale

Readmission rate is considered to be a global performance measure as it potentially points to deficiencies in the functioning of the overall mental healthcare system.

While multiple hospital admissions over a lifetime may be necessary for someone with ongoing illness, a high proportion of readmissions shortly after discharge may indicate that inpatient treatment was either incomplete or ineffective, or that follow-up care was not adequate to maintain the patient’s recovery out of hospital.

These readmissions mean that patients spend additional time in hospital and utilise additional resources. A low readmission rate suggests that good clinical practice is in operation. Readmissions are attributed to the facility at which the initial separation (discharge) occurred rather than the facility to which the patient was readmitted.

By monitoring this indicator, key areas for improvement can be identified. This can facilitate the development and delivery of targeted care pathways and interventions aimed at improving the mental health and quality of life of Western Australians.

Target

The 2021 target for readmissions to acute specialised mental health inpatient services within 28 days of discharge is ≤12.0%. Improved or maintained performance is demonstrated by a result below or equal to target.

Results

Commentary

With demand for services and patient acuity high, readmission rates have remained relatively steady when compared year on year. The result this year is a positive reflection of the strategies that have been implemented with a focus on reducing the level of unplanned readmissions to mental health inpatient services. 

These strategies include: 

• Commencement of the Youth Community Assessment Treatment Team, which provides early intervention and timely support to young adults experiencing mental health concerns. Benefits include, and are not limited to, admission diversion, prevention of readmission and facilitation of early discharge.
• Continuation of the Hostel Inreach Initiative. This project aims to increase mental health and physical health treatments and supports to an at risk/vulnerable cohort, as well as reduce ED presentations and admissions.
• Continuation of the Project Air / Dialectical Behaviour Therapy Program for Adult Community Royal Perth Bentley Group (RPBG). Project Air is a Personality Disorders Strategy that aims to enhance treatment options for people with Personality Disorders and their families and carers. A key component of Project Air is the Gold Card Clinics, which provide brief psychological interventions to frequent presenters to EDs, in the context of psychosocial crisis with emotion dysregulation, suicidal ideation or self-harming behaviour, supporting admission diversion, readmission and treatment.
• Continuation of the Active Response Team (ART) service at both RPBG and Armadale Kalamunda Group (AKG), in partnership with various Non-Government Organisation (NGO) providers of mental health services, in order to maximise the care planning and support opportunities to keep patients well in the community.
• Commencement of Momentum QP (Youth Mental Health and Alcohol and Drug Homelessness Service). EMHS’ partnership with Richmond fellowship, Anglicare and Cyrenian House, provides residents with a 12-month recovery-focused program with referrals, including from ED and mental health inpatient units. Aims include, but are not limited to, providing treatment and reducing hospital presentations, admissions and readmissions.
• St John of God Midland Head to Health offers assessment and short to medium term treatment to adults experiencing mild to moderate mental health concerns, immediate care to access information and assistance navigating to other appropriate services.

EMHS continues to strive to reduce the number of readmissions to acute specialised mental health inpatient services within 28 days of discharge.

Period: 2019 – 2021 calendar years 

Contributing sites: Armadale Health Service, Bentley Health Service, Royal Perth Hospital, St John of God Midland Public Hospital 

Data source: HMDC (inpatient separations)