An Emergency Department and Centre for Emotions and Health Collaboration

Contact: Allan Abbass 902473-2514, allan.abbass@dal.ca

www.istdp.ca

EmotionDysregulation

Physical SymptomsPhysical IllnessesLow self careSelf InjuryRelationshipsLow ComplianceComplaints

Hospital DaysEmergency useMedical VisitsTests + ProceduresExcess MedicationsPoor OutcomesDisabilityMorbidityMortality

Irritable BowelDyspepsiaAbdominal pain

FibromyalgiaFatigue

DepressionAnxietyPanic

HypertensionChest pain

ConversionPseudoneurologicalPhenomena

ChemicalSensitivity

HeadacheConfusion

Bladder dysfunctionPelvic Pain

Great Overlap Between Common Problems

PsoriasisDermatitis

Irritable BowelDyspepsiaAbdominal pain

FibromyalgiaFatigue

DepressionAnxietyPanic

HypertensionChest pain

ConversionPseudoneurologicalPhenomena

ChemicalSensitivity

HeadacheConfusion

Bladder dysfunctionPelvic Pain

Great Overlap Between Common Problems

PsoriasisDermatitis

EmotionDysregulation

SpecialtySpecialty % with 1 or more % with 1 or more unexplained unexplained symptomssymptoms

GynecologyGynecology 6666

NeurologyNeurology 6262

GastroenterologyGastroenterology 5858

Chest ClinicChest Clinic 5151

RheumatologyRheumatology 4545

TotalTotal 5252

Emergency use: ~15-20,000 visits/yr Hospital Days: ~13,000 days per yearMedical Visits: 25-50% of all new consultsExcess Tests + Procedures: ?Excess Medications: ~$150,000/yr in Hospital Suboptimal Outcomes: ? CostExcess Side effects: ? Cost: many admissionsDisability: ~$6,000,000/ year in Capital HealthMortality: a measurable excess in reviews

Info from Emergency Database, Decision Support, Occupational Health and Pharmacy

Unexplained Chest Pain, Headache, Panic, Abdominal Pain account for

16% of all CDHA ED Visits each year 

75% of all Chest Pain complaints come out with no diagnosis: 9000

visits

88% of all Abdominal Pain complaints come out with no

diagnosis: 7000 visits 

Wait Times

A method based on videotaped research to diagnose and address problems handling emotions

Effective with broad range of physical and psychological problems

Actively researched and taught in our Centre More information

http://www.istdp.ca/whatis.htm

Voluntary Muscle Tension Fibromyalgia, chest pain, abdominal pain, hyperventilation, panic attacks

Involuntary Muscle Tension Hypertension, IBS, Dyspepsia, Urinary symptoms, pelvic pain, migraine

Physical Problems treatable with ISTDP

Cognitive-perceptual Disruption dizziness, fainting, weakness, memory problems, accidents, injury, psychotic features

Motor Conversion Falling, loss of speech, spasm, weakness

21 published outcome studies Effective with multiple medical conditions and

physical symptom syndromes Marked drop in Dr and Hospital costs Majority stop psychiatric medications Around 85% of treated patients return to work

from disabilities (several studies) Single session brings 25% symptom reduction

on average Saves approximately 10 times what it costs

each year through service use and disability reduction.

How Effective is ISTDP

0

1

2

3

4

5

6

7

1 Year Pre 1 year Post

Emer

genc

y V

isits

/yr

ISTDP

Control

p<.01

p<.001

p=0.2

ISTDP reduced Repeat Emergency Visits for Medically Unexplained Symptoms Abbass, Campbell et al, Can J Emerg Med, 2009, 2010a, 2010b

Control

ISTDP

Innovation Grant to staff ED with Diagnostic Clinicians

Established long term relationship between CEH and ED

Provided videotape based education sessions to the emergency staff

Developed an information pamphlet for patients. Introduced rapid access referrals to the service

where emergency patients were seen in less than 2 weeks when possible.

Showed videotape of the emergency-referred cases we had seen.

Provided literature to emergency physician and other staff.

Provided a month of on-site consultation and liaison with emergency physicians.

3.8 sessions average Significant Improvement on symptom measure

(BSI) High Patient Satisfaction ratings (~8/10) Marked increase in referral rates by more

Emergency Doctors Major reduction in repeat Emergency Use (65-

70% reduction) “Net Cost saving” of 500 per patient Funding received for 1.2 FTE Psychologists to

staff the ED Named Canadian Leading Practice by

Accreditation Canada 2010 Nova Scotia expected to roll this program out to

other emergency departments

Simply understanding that emotional factors were responsible for symptoms was enough to reduce symptoms and ED use. Only 2 returned to ED, after assessment and during course of clinic.

Almost all patients were suitable referrals for service. Only 2 or 3 did not fit the service.

More complex patients needed coordinated Tx

While all had multiple issues, at the core of the problem was some form of attachment trauma in early life.

Nearly all were moderate resistant, highly resistant or fragile

The service is widely acceptable and well used

Patients benefit with reduced ED visits Service use reduction can help to reduce

wait times This service matches meeting the patient

at point of entry, and Exemplifies patient-centred care at Capital

Health

Canadian Journal of Emergency Medicine 2009 article: http://www.istdp.ca/docs/CJEM_2009.pdf

Journal of Academy of Medical Psychology articles on Cost Effectiveness and Implementation

http://www.istdp.ca/docs/Cost%20Saving%20ED%20Treatment.pdfhttp://www.istdp.ca/docs/Implementing%20ISTDP%20in%20the%20ED.pdf