Posted on: 20 November 2023

The Hillingdon Psychiatric Liaison Team has reduced the time taken from a patient’s arrival in A&E to their onward referral for a mental health assessment by 56 percent after conducting a quality improvement project.

Ahead of the project, the team identified four main challenges they wanted to overcome:

  1. The Single Point of Access Team wasn’t being informed that the police were arriving at A&E
  2. The reasons for referral to A&E were often unclear, causing delays
  3. There was a lack of clarity regarding the need for medical optimisation
  4. Once in A&E, patients seemed to get lost/forgotten in the system

Using patient feedback and working closely with experts by experience, the team used a plan/do/study/act (PDSA) cycle to start tackling these issues.

They used police interface meetings to discuss and reinforce the proper procedure for contacting SPA. It was agreed that SPA should be contacted as soon as the patient is fit to be assessed, so a Health Based Place of Safety can be found and the patient can be transferred more quickly.

To improve the clarity of referrals to A&E, the Psych Liaison Team has requested that all staff spell out the exact reasons a patient has been directed to A&E.

Finally, they developed a process map and local guidelines to not only help the flow of S136 patients through A&E but also to identify other areas for improvement.


As you can see from the diagram above, the QI project has been a resounding success. The time taken from a patient’s arrival in A&E to onward referral has dropped by an impressive 56 percent.

But the team wants to get even better.

They already have plans to bring more staff on board, increase patient involvement, and integrate feedback from the emergency department mental health lead.

They are also looking for ways to speed up the data entry process, as it is laborious but has to be done manually.