Abstract
Introduction:
Older people admitted to psychiatric hospitals are a highly vulnerable population, often with multiple comorbidities and complex medication regimens. National data estimates premature mortality of 10–20-years for people with severe mental illness, largely driven by physical health disparities. In older age psychiatry, this risk is compounded by frailty, dementia and polypharmacy. Basic physical health assessment is a cornerstone of safe, high-quality care. For older patients in psychiatric hospitals, this extends beyond routine monitoring for cardiovascular risk, metabolic side effects of antipsychotics and neurological complications. Many live with long-term comorbidities such as heart failure, CKD and COPD and may present with acute illness. Where equipment to support thorough assessment is unavailable, potentially manageable conditions often necessitate transfer to acute hospitals, despite the presence of clinicians on site who could provide appropriate care if adequately equipped. Avoiding this is especially important in dementia wards, where patients may become unsettled if transferred out of their familiar environment.
Method:
A re-audit of physical health equipment was undertaken across four wards (2 dementia specialist, 2 functional) at a psychiatric hospital for older adults (>65 years). Availability and functionality of equipment were checked against the Care Quality Commission recommendations and items required for NICE antipsychotic monitoring. This repeated a 2023 audit using the same criteria.
Results:
All wards were missing essential equipment, with 17.5-35% of recommended items unavailable. Several essential items were expired or non-functional including urinalysis sticks, blood bottles and the sole otoscope/ophthalmoscope. Examination couches were absent on two wards, limiting capacity for basic examination. ECG machines were available but variably functional.
Conclusion:
Significant gaps persist in equipment provision, limiting safe assessment and management. Ensuring access to reliable equipment would allow clinicians to provide appropriate care and reduce unnecessary hospital transfers for this frail and vulnerable population.
Comments
Very overlooked but relevant topic
A valuable and clearly presented re-audit addressing an often-overlooked aspect of patient safety in older adult psychiatry. The findings highlight significant equipment gaps that directly impact quality of care and patient experience. The project effectively underscores the importance of infrastructure in enabling safe physical health assessment and reducing unnecessary hospital transfers. Strong relevance and clear implications for service improvement.