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Table 2 Original categories, example standards, and supporting quotes, identified from the qualitative work

From: Developing a model of best practice for teams managing crisis in people with dementia: a consensus approach

Category Example Quote Original standard
Service purpose So we get a lot of referrals asking us ‘Please can you just maintain contact’ or ‘Please can you just pop in a keep visiting this person’. As much as we would love to do that, we are not commissioned to do that, and we don’t have the staffing to do it. (Staff 04–02) Staff members are aware of the aim of the service and can communicate it clearly to other healthcare professionals, service users, and people who support service users (e.g. family carers)
Team values He kept looking at his watch, you see, and I thought, I know they’ve only got so much time.
(Carer - 05-08)
Service users and carers should not feel rushed during face to face contact with service users and carers
Reflexivity So for about two hours we just talk about what is going on in the team, like how we can improve, like anything wrong that we need to iron out. (Staff 03–02) Team members are informed of quality improvement of the service, team performance, policies, changes, and development opportunities
Coordination of the service They always just did exactly what they said they would do (Carer 01–05) The team is reliable in keeping appointments and then actioning what is agreed
Decision making I will work out my case load and who is the priority and within my case load I have got at the moment somebody who needs seeing weekly. I will work out with them what they need at that time (Staff 04–03) Team members are able to make day to day decisions autonomously
Outcomes It’s really, really hard to quantify a person’s recovery (Staff 02–04) Outcome measures are appropriate to the service user and carer’s needs and can document their progress whilst in contact with the team
Accessibility of the service Sometimes most of the feedback we get is ‘you call yourself a crisis team?’, you know when someone is in dire need of help and they call in the office about 9 o’ clock … you just almost wish someone was there (Staff 01–04) The service is operational during hours that are appropriate to patient needs
Responsiveness of the service So we sort of put them in terms of their needs to red, amber, green, or inpatient and that would determine the contact we make (Staff 01–03) The service prioritises service users according to level of risk to themselves or others involved in their care
Staffing the service Band 6 s would be expected to go and see somebody in their own home because of the risks involved … whereas a band 5 would do this in the care home because there is always people around afterwards (Staff 03–01) There are clear job roles and boundaries within bandings for team members
Leadership The good thing about the team here is the manager, one of the managers [manager name] is actually more based, she used to work in older people’s services so she understands older people’s services much better, the needs of people with dementia (Staff 02–03) The team leader has specialist knowledge in older adults and dementia
Supervision and training Yes and we ran a training course, me and my colleague here, on safeguarding and procedures and things like that and the Managers attended and the Psychiatrists attended, you know it was kind of, it was and then the Psychiatrists run training on areas that we feel we are lacking as well and so it’s good, exchange is good (Staff 02–04) Team members have the opportunity to engage in training led by experienced and senior members of the team
Joint working Some of the referrals aren’t very deep, three or four lines. Some of them are brilliant, they give you loads of information. But others they don’t. It can be a bit frustrating (Staff 04–01) Crisis teams are explicit with GPs about what information is required in a referral, and what physical health checks must be completed prior to referrals
Team base environment We hot desk, which is a bit of a nightmare if there’s no computers, but we’ve all got laptops, so you can be sat on your knees sometimes at a little desk in the corner (Staff 02–04) The crisis team have access to an appropriate space to facilitate MDT meetings, complete paperwork and conduct telephone calls
Referrals I can’t even make a guess [at referral rates] (Staff 03–02) Service user flow should be measured for the purposes of service planning and all team members are made aware of this information
Assessments I didn’t want to do writing. Writing has been a down-turn for me all my life (Service User 01–21) The purpose and outcomes of assessments conducted by the team should be clearly explained to service users and carers
Psychosocial interventions Well mostly they would sit and talk to you and just give you tips on how to handle dementia … he would say ‘well, next time why don’t you try this’ or ‘maybe he did that because …’. Do you know what I mean? (Carer 01–05) The team provides education and support to carers to help them support the service user at home, which may include information about dementia, including basic information about what diagnosis the service user has and what the symptoms may include and signposting to available resources and services for service users and carers where relevant
Pharmacological interventions Medication reviews, just like is part and parcel of what you would do if you get called out. (Stakeholder Focus Group 01) The team should review or be able to arrange for a review of medication that the service user is prescribed
Onward referral And then they would come perhaps a couple of times and then they would say, “well we think everything is ok now, we are going to close the books on you” which is the one thing that I find a bit unacceptable really, because the trouble is, once they have closed the book down on you, you then have to get in touch with your doctor and get the doctor to call them out again (Carer 03–17) Service users and carers are adequately prepared for discharge from the service, are aware of how to re-access the team if necessary and are involved in the decision to discharge. Written and face-to-face information is offered.