Acute care: FIRE MAPP

Introduction

Frontline Integrated Response and Evaluation for Mental and Physical Problems (FIRE MAPP) launched in February 2016 as a high impact, innovative pilot educational project aimed at improving care for complex patients with mental and physical health issues in acute settings.

The principles were to promote collaborative multi-disciplinary learning between mental and physical health disciplines exploring ways of addressing the upward trend in adverse incidents involving patients with mental health backgrounds within the King’s College Hospital Acute Medical Unit (AMU) through a range of educational strategies.

The project is run by forward facing faculty from the King’s Postgraduate Medical Education Centre (PGMEC), the Trauma, Emergency and Acute Medicine (TEAM) Division at King’s College Hospital and South London and Maudsley NHS Foundation Trusts.

Background- the case for change

The project aimed to increase knowledge and confidence in handling this complex group of patients. To challenge perceptions and clarify misconceptions around the management of challenging patients in acute settings, and to improve the front-door response for acutely unwell patients with mental health backgrounds.

It also sought to encourage and empower staff to work together as an interdisciplinary team at the mental/physical health interface to promote holistic care and reduce risk for these vulnerable patients.

How?

The project was enabled through a successful bid led by Consultant Physician Dr Shairana Naleem (Acute Medicine Department) for a Health Education South London (HESL) strategic innovation grant of £29,038, awarded in October 2015.FIRE MAPP team

It was supported by Dr Sean Cross, Head of Maudsley Simulation and Clinical Director for the King’s Health Partners Mind and Body Programme. The team worked with the Post Graduate Medical Education (PGME) department to commission a brand new multidisciplinary half-day course that included high fidelity simulation with actors, case-based discussions and group work all modelled on actual adverse incidents affecting King’s College Hospital Acute Medical Unit.

In total more than 45 staff from both trusts were trained, including AMU nurses, registered mental health nurses, medical and psychiatry doctors, therapists and medical students. The results were extremely positive, with approximately 90% of participants stating they felt more knowledgeable about the approach to managing patients with mental health disorders presenting with acute medical problems, as well as feeling more confident in managing patients with challenging behaviours in acute settings and being mindful of preconceptions that contribute to stigmatisation.

Course director and FIRE MAPP lead, Dr Shairana Naleem, said:

FIRE MAPP has been a challenging, exciting and unique project, and the impact of how it has translated into sustainable practice has been overwhelming, as evidenced by experiences recounted in our focus groups and narrative interviews. I especially want to thank the acute medicine, psychiatry and education teams for their invaluable support on this journey and I hope we can continue to embed this key learning in the training of our frontline multidisciplinary staff to reduce risk and improve outcomes, through empowering our staff and increasing collaboration across the acute mental/physical interface in practice.

Outcomes

Staff from the TEAM Division at the trusts were recognised at the Society of Acute Medicine’s Annual International conference in Edinburgh (September 2016), where they won awards for the FIRE MAPP project. The team took home two prizes, one for the best oral presentation, and another highly commended award for their poster summarising the high impact findings of FIRE MAPP.

HESL has published this on their website and plan to include the outcome in their national newsletter. They have asked the facilitators to share their experiences in upcoming training workshops to encourage broader development of such projects.

As a result TEAM is now looking to prioritise future training in high risk areas within acute and emergency medicine as well as working together with King’s Health Partners in contributing to the wider mind and body strategy.