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Birmingham and Solihull Mental health NHS Foundation Trust
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Psychiatric Decisions Unit (PDU)

The PDU was developed to provide an alternative pathway for patients accessing emergency departments and other services, such as the police and ambulance services.

It is acknowledged that emergency departments are busy, high stimulus environments and are not the ideal place for patients suffering with mental health difficulties in crisis. Added to the environmental issues, emergency departments are under pressure to assess and treat patients quickly. If service users are referred to the PDU, time pressure on both service users and clinicians is reduced.

The Street Triage team also supports service users accessing the PDU when they require a safe environment for ugent assessment.

The PDU is an ambulant assessment area which provides a calming environment for the assessment and development of treatment plans for more complex service users who are in crisis and are accessing emergency services. The reduction in time pressure enables the service user to think through more clearly the nature of their crisis and the sort of help they need to recover, both over the short and long term, and gives clinicians time for more thorough, ongoing assessment. This enables treatment plans to be tailored to the needs of the service users, making full use of community services, and is less likely to result in an inpatient episode.

The aim of the PDU is to provide an environment and atmosphere that is conducive to enabling service users to relax, and to provide high quality, thorough assessment, leading to well developed, service user-centred  treatment plans. This will enable the service user to both manage their immediate crisis and place them onto a (usually community based) pathway, leading to more robust recovery.

An initial evaluation of the service has shown:

  • The increasing number of patients diverted from emergency departments by Street Triage.
  • Number of bed days which were not used by BSMHFT patients who would previously have been admitted.
  • Patients, staff and other stakeholders are very positive about the service provided by the PDU as an alternative pathway out of A&E.
  • Results of patient satisfaction surveys have shown the vast majority of patients are extremely satisfied with the service provided to them at the PDU. Many have reported that they find the PDU a much better environment than acute hospital emergency departments. Feedback from other stakeholders have shown that staff working at BSMHFT see the benefit to patients of the PDU.
  • In 2014, between March and August, 298 people were admitted either formally or informally to an inpatient bed via a Rapid, Assessment, Interface and Discharge team. In 2015 across the same time frame (March to August) 219 people were referred to an inpatient bed via this service. This indicates a 26% decrease in inpatient admissions as a result of the PDU opening.
  • The number of inpatient bed days saved due to referrals to the PDU was 6,900 days.
  • Between March and August 2014, the Street Triage team brought 297 patients directly to A&E.
  • In the same time frame in 2015, Street Triage decreased the number of patients going to emergency departments by 39% through the use of PDU.