"Problems with emergency referrals to "Access and Assessment Service""
About: Norfolk and Suffolk NHS Foundation Trust / Liaison psychiatry Norfolk and Suffolk NHS Foundation Trust Liaison psychiatry NR6 5BE
Posted by AnEmergencyDoctor (as ),
I have always had a frustrating experience trying to refer acutely mentally unwell Emergency Department patients to this service. It is always difficult to persuade the service to come and assess the patients.
They will flatly refuse to see a patient unless they are "medically fit", irrespective of the Royal College of Psychiatry guidelines which state that patients who have medical problems which do not affect their mental state are fit to be assessed. The service will often insist over the phone that our patients are "not medically fit" despite senior A&E clinicians who have physically seen and examined the patient deeming them to be medically fit. In my opinion it is absolutely unprofessional to draw such a conclusion over the phone without having seen the patient, especially when a senior clinician experienced in the relevant field has deemed so otherwise.
Yesterday I had a psychotic patient expressing clear delusions, with a history of psychiatric admissions, who was established on a atypical antipsychotic so was highly likely to be known to the local Mental Health service. After establishing that the patient was medically fit via an extensive examination and review of blood tests, I contacted the service.
I was told that "we can't look up any information because our computer system is broken". I was rung back an hour later being told that "we're not coming to assess the patient because we think it's probably a UTI".
They had not seen the patient, had not taken a history and had not consulted the blood results. I had to divert staff from a serious case in the Resuscitation room to obtain an unnecessary urine dip, to prove to Norfolk and Suffolk NHS Trust Access and Assessment Service that my patient was not suffering from a UTI. The urine dip was negative, so I rang the service back and after some resistance got them to agree to assess the patient. Upon arriving, they then decided to send the patient home and assess them the following day instead.
The service staff I have met have come across as bone-idle and obstructive. They have discounted expert opinion from other senior clinicians in order to avoid having to come and assess patients. They have asked for extra unnecessary tests to be performed to delay having to come out.
I have never had a helpful experience when referring patients.