Association between continuity of care and attendance of post-discharge follow-up after psychiatric emergency presentation

Background: The number of accident and emergency (A&E) hospital attendances by young people aged 18 or under with a recorded diagnosis of a psychiatric condition more than tripled between 2010 and 2022. After discharge from the hospital, attendance at follow-up appointments in the community is critical to ensure the safety of young people and optimise the use of clinical resources Aims To evaluate the association between follow-up attendance and the continuity of clinicians and clinical teams. Method A retrospective cohort study was conducted using electronic clinical record data from East London NHS Foundation Trust (ELFT), between April 2019 and March 2022. Multi-level mixed effects logistic regression was performed to model the follow-up attendance odds based on whether the same or different clinician and clinical team offered the initial A&E and the community follow-up appointment or whether a crisis team was involved. Results 3134 A&E presentations by 2368 young people were identified within the study period. Following these presentations, 2091 follow-up appointments in the community were offered. The attendance rate increased by more than three times if the follow-up appointment was offered by the same clinician who saw the young person in A&E (odds ratio (OR) = 3.66; 95% CI 1.65–8.13). Whether the same clin ical team provided the community follow-up appointment, or whether a crisis team was involved before discharge made no difference to the likelihood of follow-up attendance. Conclusions The findings support the importance of the continuity of clinicians in the care of young people in crisis. Crisis service planners and policymakers should prioritise the continuity of clinicians in mental health service models and rota planning.