Proactive Mental Health Assessments in the Emergency Department to Improve Care

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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 1

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This presentation was delivered in session A3 of Quality Forum 2014 by: Yogeeta Dosanjh Integration Primary & Community Care Lead, Powell River and Sunshine Coast Regional GP Practice Integration Coordinator Vancouver Coastal Health Nora Koros Manager, Mental Health and Addictions, Powell River Vancouver Coastal Health Debbie Hodges Patient Care Coordinator, Inpatient Psychiatry, Powell River Vancouver Coastal Health

Transcript of Proactive Mental Health Assessments in the Emergency Department to Improve Care

Page 1: 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)

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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

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Successes Shown in the Following Areas

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Interdisciplinary Team Approach

Transitions of Care

Sustainable Practice Approach

Patients as Partners Approach

Enablers including linked systems

Acute Health Utilization Cost Benefit

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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

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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

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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

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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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