Project Leads: Dr Chiara Petrosellini, Dr Monika Gorny, Dr Paul Gyimah, Dr Saira Chowdhary, Dr Pollyanna Cohen, Dr Neil Sarkar
 

Where did the idea for your QI project first come from?

"(Chiara) I have always had an interest in Psychiatry as well as in obstetrics and gynaecology. A few years ago I met a Consultant Psychiatrist at an event where we ended up discussing the difficulties females on the inpatient PICU ward can have accessing sexual and reproductive healthcare (SRH). They are often vulnerable, too unwell to seek help, they may have engaged in more risk-taking behaviour due to being disinhibited which puts them at greater risk of STIs and unplanned pregnancies. This was where the idea for the QI project first started. "

"We developed an initial survey to ask patients and staff on Ruby ward for their views on access to SRH and what improvements they would like to see. Staff reported that SRH issues came up regularly but that they didn’t feel equipped to manage them. 80% of patients reported they were sexually active with only 6% always using contraception. Of those sexually active women, only 50% had had an STI screen in the preceding year. 38% of women reported they hadn’t had their smear test within the recommended time frame. 93% of women felt they would find it helpful to discuss at least one sexual/reproductive health issue during their psychiatric inpatient stay."

What were the project interventions?

"There were three main areas we focused on. The first was setting up an in-house women’s SRH clinic on Ruby ward where female patients could access basic healthcare. The clinic was led by Obstetrics and Gynaecology Registrars alongside a Sexual and Reproductive Health Registrar. These doctors were running the clinic in their own time without funding due to their commitment to improving healthcare access for these women. The aim was to have clinics bi-monthly but due to resources they ended up running once a month. The clinics ran for around 1 year.

The second area was developing an education pathway for staff which involved delivering monthly teaching for staff on topics such as the menopause, contraception and STIs. We had a core set of 6 teaching sessions which we repeated.

The third area was developing an imaging pathway whereby women could access pelvic scans whilst they were still inpatients. This involved close liaison with UCLH to set this up and arranging hospital transport for patients. Often there is a wait for women to have these scans and historically what would happen is that a plan would be put in place for them to have it as an outpatient but then once discharged from the inpatient ward they wouldn’t attend. Through our pathway, we have ensured that this doesn't happen, and that women who require a pelvic ultrasound for acute or chronic gynaecological concerns can have this done promptly, and whilst they're still inpatients at Highgate Mental Health Centre."

What were your measures?

"As described previously, we collected baseline data via a staff and patient survey to try to understand what the need was. We collected data on the number of referrals to the clinic each month and the reasons for referral. We also gave a feedback form to each patient who attended the clinic to collect quantitative and qualitative data on their experience."

How did you engage staff in the project?

The Registrars who volunteered at the clinic all had an interest in improving access to healthcare for vulnerable women. We put together a marketing campaign to promote the clinic to other staff members and patients which included; weekly reminders, distributing leaflets and posters and advertising the service at the monthly teaching sessions.

What were some of the challenges?

"One of the main challenges was that we didn’t have any funding which meant that we were unable to run the clinic as frequently as we would have liked. We are currently in the process of putting a business case together for this. We also struggled at the beginning of the project to get the equipment we needed on Ruby ward, this took some time but we now have a well-equipped room with an examination couch and light. Another challenge was that sometimes a woman, who was not very well, would come to clinic and if she didn’t have an escort who knew her well it could be difficult to get a good history to understand what her health issues were."

How will you sustain this project?

"We think having funding will help with the sustainability of this project as it will remove the need to rely on doctors providing the service in their free time. We were very lucky having Paul (Resident Doctor) lead the advertising and organisation of each clinic, it really helped them to run smoothly. He has now left Ruby ward so we will need to see if we can find another Resident Doctor to take on this role supported by us."

What were the main learning points from your project? 

"We think there were two main learning points. First, the importance of wider cooperation between different specialties can help improve care and can also help break down barriers and pre-conceptions. Secondly, these women are vulnerable and often have complex needs and this project has helped improve access to basic healthcare for them."