Taking the next step: Improving care transitions from a first-episode psychosis service

Aims First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these time-limited services. Methods A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months is presented. A planning phase was followed by recurrent Plan-Do-Study-Act cycles (PDSA) that included the introduction of proactive efforts targeting disposition planning (with patients and families) and follow-up to facilitate transfer after discharge. Fisher’s exact test was used to compare disposition and transfer outcomes across the QI phases. Results This QI approach was sustained through a three-fold escalation in discharge volume. Transfer status at three months was significantly different between the pre- and post PDSA phases (p=0.02). A greater proportion were confirmed transfers post-PDSA (54.3% vs. 37%), but of those with known status at 3 months, similar proportions were successfully transferred (76%, 73%). Patients discharged post-PDSA were less likely to have unknown treatment status (26% vs 51%). Disposition outcomes were also significantly improved post-PDSA (p=0.03). Patients were more likely to engage with discharge planning (69.7% vs. 48.6%) and less likely to be lost to follow-up (13.8% vs. 25.7%), or to refuse assistance (11.0% vs. 20.0%). Conclusion This QI approach offers a feasible way to improve disposition and transfer after FES and can be built upon in efforts to sustain functional gains in onward pathways.