Enhancing patient engagement and positive step-down discharges through co-production: a quality improvement initiative in an in-patient rehabilitation psychiatric unit [Abstract]

Tahseen, H., Hassoulas, D. A. ORCID: https://orcid.org/0000-0002-1029-1847 and Umla-Runge, K. ORCID: https://orcid.org/0000-0002-9615-8907 2025. Enhancing patient engagement and positive step-down discharges through co-production: a quality improvement initiative in an in-patient rehabilitation psychiatric unit [Abstract]. European Psychiatry 68 (S1) , S805. 10.1192/j.eurpsy.2025.1638

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Abstract

Introduction This Quality Improvement (QI) programme aimed to integrate co-production principles into rehabilitation psychiatry to enhance patient-centred care and facilitate positive step-down discharges. The initiative was developed in response to suboptimal audit results, revealing low patient attendance and limited positive discharges within an in-patient psychiatric unit. Recognising the critical role of rehabilitation psychiatry in supporting recovery and reintegration, the programme sought to transform patient engagement through equitable partnerships between patients and healthcare professionals. Objectives The programme’s primary objectives were to: 1. Implement and evaluate co-production within the Care Programme Approach (CPA). 2. Increase patient attendance at CPA meetings and improve positive step-down discharges. 3. Enhance engagement, communication, and shared decision-making to achieve better patient outcomes, including reduced anxiety. Methods A phased approach was employed, encompassing diagnostic, problem-solving, and evaluation stages. Root cause analyses were conducted using fishbone cause-and-effect diagrams and the 5-Why Technique. The Model of Improvement guided the programme, with change ideas developed and refined through Plan-Do-Study-Act (PDSA) cycles. Interventions included distributing patient information leaflets, staff training sessions, and introducing a structured CPA agenda template. Quantitative analysis using paired t-tests evaluated changes in attendance, discharge rates, and Hamilton Anxiety Rating Scale (HAM-A) scores. Qualitative data were gathered from a co-produced CPA questionnaire, with emerging themes integrated into the project’s evolution through narrative synthesis. Results The implementation of co-production yielded significant improvements in patient engagement and discharge outcomes, resulting in a 50% increase in CPA meeting attendance and a 70% positive step-down discharge rate. Interventions were associated with reduced anxiety levels, evidenced by improvements in HAM-A scores. Qualitative analysis highlighted key themes, including challenges during community transitions, empowerment through shared decision-making, and enhanced communication with healthcare professionals. The structured CPA agenda template further improved patient-centred communication and care experiences. Conclusions The integration of co-production within rehabilitation psychiatry fosters transformative partnerships that enhance patient engagement and clinical outcomes. This QI programme demonstrates the efficacy of patient-centred interventions, supported by structured communication tools, in empowering individuals, reducing anxiety, and improving transitions to community care. Co-production provides a robust framework for advancing rehabilitation psychiatry and optimising patient care pathways.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Cambridge University Press
ISSN:	0924-9338
Date of First Compliant Deposit:	17 September 2025
Last Modified:	17 Sep 2025 11:47
URI:	https://orca.cardiff.ac.uk/id/eprint/181121

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