Proactive Mental Health Assessments in the Emergency Department to Improve Care
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Transcript of Proactive Mental Health Assessments in the Emergency Department to Improve Care
PRO-ACTIVE MENTAL HEALTH ASSESSMENT IN THE EMERGENCY DEPARTMENT TO IMPROVE CARE
An Integrated Primary & Community Care Powell River Initiative
N. Koros, D. Hodges,
L. Ringaert, Y. Dosanjh BC Patient Safety & Quality Council Forum
February 27-28, 2014
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Powell River IPCC • Integrating Primary and
Community Care (IPCC) a provincial initiative aimed at integrating physicians, health authority programs, and staff to provide more:
• Coordinated, effective and efficient care
• Resulting in better patient, provider experiences,
• Better patient outcomes, and greater cost effectiveness for the system.
• Powell River is one of the IPCC communities of care
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VCH IPCC Vision
Patients and families, family physicians,
community care and acute care providers working as a team for better patient care
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The Emergency Department and Mental Health Inpatient Psychiatry unit developed a
new process to better respond to mental health patients to improve their care by
better coordination
The process also involves better coordination and integration with
community mental health and family physicians
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Key Dates
Jan 2011 Started to Plan
& Develop Process
Dec 2012 Began to roll out the standardized
process
Aug-Dec 2013 Evaluation
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What Was It Like Before? • Siloed approach • Acute mental health only consulted for “problem”
patients • Lack of:
– objective assessments – understanding by ED of what Acute MH could offer
• ED staff feeling overwhelmed • Inadequate connection to community mental health • Inadequate connection to Family Physicians • Inconsistencies in care and approach with patients
(providers not sharing the care plan)
February 4, 2014 6
The New Process
Contact from ED
In Patient Nurse collects E-Records
including CMH
In Patient Nurse visits patient in ED
Conducts MH assessment
Consults with ED Physician/Staff
Careplan created
Notification sent to GP
Care conference initiated if urgent
Notification sent to Community MH
Decision to Admit or Discharge
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The Critical Connector: the InPatient Psychiatric Nurse
the InPatient
Psychiatric Nurse
ED Physician
& Staff
Family Physician
Psychiatrist
Community Mental
Heath Staff
Child Youth Mental Health
Patient
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Evaluation (2013) • Feedback sessions with representatives of the in-patient
mental health team and with the community mental health team
• Key stakeholder interviews with the manager and with two family physicians
• A survey to emergency department staff and physicians on feedback on general improvement initiatives that included questions on the In-patient mental health consults to the ED
• Analysis of health utilization data • Analysis of assessment data
January 2014 9
Successes Shown in the Following Areas
February 4, 2014 10
Interdisciplinary Team Approach
Transitions of Care
Sustainable Practice Approach
Patients as Partners Approach
Enablers including linked systems
Acute Health Utilization Cost Benefit
Key Success
The key Success is the improved continuity of care and the integration of care
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Assessment Tool Critical to Success
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“This pilot allowed us to create an ED assessment using an
evidence-based tool that gives us a comprehensive standardized assessment of the patient as a
whole”
InPatient Psychiatric Nurse
Improved Link to ED
CMH Team member
CMH Team member
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“We hear that the ED Staff are relieved that
someone knows how to do the suicide
assessment and feel supported as it’s a
collaborative effort”
“Now, there is a link with ED with no delay in
information retrieval”
“I am getting less calls from the ED and it feels
like I am having less direct admissions from
ED”. Family Physician
Better for Patients
• Familiar person sees them in the ED
• More thorough assessment provides better care
• MH nurses have the time that the ED Staff did not have
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Health Utilization Successes • Reduced ED visits through comprehensive
assessments • Urgent community appointment through
advanced access appointment • More timely care planning and follow-up
for patients. • Improved communication with the primary
care physicians.
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0
10
20
30
40
50
60
PT #1 PT #2 PT #3 PT #4 PT #5 PR #6 PT #7 PT #8
No. of Visits
Patients
Powell River Emergency Department Mental Health Visit
VISITS 2009
VISITS 2010
VISITS 2011
VISITS 2012
VISITS 2013
VISITS 2014
Challenges
• Acute Nurse Off the Ward
• Communication with Family Physicians
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Summary • Overall Success • Always room for improvement • Evaluation was valuable in illustrating
areas we can further improve • Next steps:
– Engage with family physicians – Continue on going evaluation/data collection – Consider patient survey – Continue to engage staff
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Thank You For more information please contact:
Nora Koros at: Manager Mental Health & Addiction Services, Powell River Vancouver Coastal Health [email protected] Ph: 604-485-3302
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