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. Rapid readmissions place pressure on finite beds and may reduce access to care for other consumers in need.

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 2023 target for readmissions to acute specialised mental health inpatient services within 28 days of discharge is ≤ 12.0 per cent. Improved or maintained performance is demonstrated by a result below or equal to target. 

Results

Commentary

With demand for mental health services and patient complexity remaining high, readmission rates remain relatively steady when compared year on year. EMHS continues to progress wrap-around type services that have been implemented to minimise the need for patients to be readmitted to a hospital setting. 

These services include: 

• The EMHS Crisis Resolution Home Treatment Team – Kadadkiny Marr Koodjal Mia (Noongar language) – at Armadale Health Service. This service provides an innovative, evidence-based response to acute mental health care by providing people with safe and high quality hospital level care in their own home. A multi-disciplinary team provides intensive support for consumers during the crisis phase and where hospitalisation or presentation to an emergency department (ED) could be avoided. The multi-disciplinary team consists of a wide range of disciplines including Aboriginal Health Liaison Officers and Peer Support Workers.
• EMHS completed an evaluation of the Active Recovery Team (ART) service, which is a pilot initiative focused on providing targeted intensive community mental health treatment using an integrated care approach to support people who have had frequent ED and inpatient admissions and have complex needs. The evaluation demonstrated positive trends towards a reduction in ED presentations with the service. 
• EMHS Eating Disorders Specialist Service commenced in a phased approach. Phase 1 commenced August 2023, accepting step-down referrals from acute inpatient care. Phase 2, community mental health referrals, commenced from 27 November 2023. This service provides a multi-disciplinary approach to help support people with eating disorders with early discharge, prevention of future readmission, and prevention of admission for people stepping up from the community.