Proactive Mental Health Assessments in the Emergency Department to Improve Care

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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

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Proactive Mental Health Assessments in the Emergency Department to Improve Care

  1. 1. 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
  2. 2. 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 2
  3. 3. VCH IPCC Vision Patients and families, family physicians, community care and acute care providers working as a team for better patient care 3
  4. 4. 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 4
  5. 5. Key Dates Jan 2011 Started to Plan & Develop Process Dec 2012 Began to roll out the standardized process Aug-Dec 2013 Evaluation 5
  6. 6. 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
  7. 7. The New Process Contact from ED Careplan created Notification sent to GP Care conference initiated if urgent In Patient Nurse collects E-Records including CMH Consults with ED Physician/Staff Notification sent to Community MH In Patient Nurse visits patient in ED Conducts MH assessment Decision to Admit or Discharge 7
  8. 8. The Critical Connector: the InPatient Psychiatric Nurse ED Physician & Staff Family Physician Patient the InPatient Psychiatric Nurse Child Youth Mental Health Psychiatrist Community Mental Heath Staff 8
  9. 9. 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
  10. 10. Successes Shown in the Following Areas Acute Health Utilization Cost Benefit Enablers including linked systems Patients as Partners Approach Sustainable Practice Approach Transitions of Care Interdisciplinary Team Approach February 4, 2014 10
  11. 11. Key Success The key Success is the improved continuity of care and the integration of care 11
  12. 12. Assessment Tool Critical to Success “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 12
  13. 13. Improved Link to ED “Now, there is a link with ED with no delay in information retrieval” CMH Team member “I am getting less calls from the ED and it feels like I am having less direct admissions from ED”. “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” CMH Team member Family Physician 13
  14. 14. 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 14
  15. 15. 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. 15
  16. 16. Powell River Emergency Department Mental Health Visit 60 N o . o f 50 40 VISITS 2009 V i s i t s VISITS 2010 30 VISITS 2011 VISITS 2012 20 VISITS 2013 VISITS 2014 10 0 PT #1 PT #2 PT #3 PT #4 PT #5 PR #6 PT #7 PT #8 Patients 16
  17. 17. Challenges • Acute Nurse Off the Ward • Communication with Family Physicians 17
  18. 18. 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 18
  19. 19. Thank You For more information please contact: Nora Koros at: Manager Mental Health & Addiction Services, Powell River Vancouver Coastal Health Nora.Koros@vch.ca Ph: 604-485-3302 19

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