Managing the Demand of Mental
Health Consumers in ED
Bridget Organ
Manager Mental Health
Background
St Vincent’s Mental Health


Catchment covers the City of Yarra and Boroondara with a combined

population of ...
Acute In-Patient Service

Page 3
St Vincent’s Hospital
St Vincent’s Melbourne provides
medical and surgical services,
sub-acute care, aged
care, correction...
Data
.

There are approximately 42,000
presentations to ED annually, one
third is admitted and 2 thirds not
admitted

Page...
Services in ED

ALERT (Care Coordination for people with complex needs in the
ED), Addiction medicine.

Mental health ser...
Data

Mental Health
On average per month there are:
• 325 MH presentations per month to ED
• 9% are brought to ED by Polic...
Data May 2013
Average LOS :
• admitted consumers is 6 hrs 30mins
• non admitted consumers is 4 hrs 20 mins
% of consumers ...
Mental Health Patient Flow

The main reason for delays
from ED to a MH bed is
access to beds, in particular
HDU beds follo...
Other factors
 In patient average LOS is 12 days with long stay consumers over
35 days - 32%
 Short lengths of stay and ...
So what is the answer to these challenges?

Day/Month/Year

Footnote to go here

Page 11
A whole of system approach is needed

Day/Month/Year

Footnote to go here

Page 12
Whole of service approach includes:
• Community teams
• CL team
• Inpatient team
• ED teams
• Broader health service

Day/...
What we are doing
Communication process to create an understanding in mental health
bed management and patient flow:
 Edu...
What we are doing

 Admitting Officer role
 Acute Care Transition Coordinator-discharge focus, contacts Case Manager
or ...
What we are doing
• Extended Triage
•

MH HARP

•

Escalation process if discharge delayed for ED

•

Daily review of all ...
What we are doing
 Weekly review of service integration and collaboration (MH, ED,
ALERT)
 Working with Police and Ambul...
What we are doing
 Increased resources for treatment of drug and alcohol presentations
 Productive Mental Health Ward pr...
Has anything changed?

Day/Month/Year

Footnote to go here

Page 19
Yes it has – a bit
January 2014
Average LOS in ED :
 admitted consumers is 5 hrs 48mins (was 6 hrs 30 min)
 non admitted...
The future
 PARC development
 Review of High Dependency beds
 ? PAPU

Day/Month/Year

Footnote to go here

Page 21
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Bridget Organ, St Vincents Hospital Melbourne: A Mental Health Perspective on Bed Management and Patient Flow-A Whole System Approach to Managing the Demand

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Bridget Organ, Manager Mental Health, St Vincent’s Melbourne delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals.

Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14

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Bridget Organ, St Vincents Hospital Melbourne: A Mental Health Perspective on Bed Management and Patient Flow-A Whole System Approach to Managing the Demand

  1. 1. Managing the Demand of Mental Health Consumers in ED Bridget Organ Manager Mental Health
  2. 2. Background St Vincent’s Mental Health  Catchment covers the City of Yarra and Boroondara with a combined population of 240,000  An adult service which is predominantly community based providing acute community based assessment and treatment, case management, residential rehabilitation, homeless outreach and Psychiatric Triage and Emergency Department services  Regional eating disorders day patient program  44 bed in-patient unit (5 Aboriginal beds)  State-wide and regional services  Aged Persons Mental Health Service Page 2
  3. 3. Acute In-Patient Service Page 3
  4. 4. St Vincent’s Hospital St Vincent’s Melbourne provides medical and surgical services, sub-acute care, aged care, correctional health, mental health and a range of community and outreach services. St Vincent’s employs more than 5,700 staff and has 880 beds and one of the busiest Emergency Departments in Victoria. Day/Month/Year Footnote to go here Page 4
  5. 5. Data . There are approximately 42,000 presentations to ED annually, one third is admitted and 2 thirds not admitted Page 5
  6. 6. Services in ED ALERT (Care Coordination for people with complex needs in the ED), Addiction medicine. Mental health services:  Psychiatric triage 24/7  Extended triage 7 days/week  ED Mental Health (ECAT) 24/7 Page 6
  7. 7. Data Mental Health On average per month there are: • 325 MH presentations per month to ED • 9% are brought to ED by Police; 56% by Ambulance • 30 consumers admitted per month via ED • Psychiatric triage receives on average 900 calls per month Page 7
  8. 8. Data May 2013 Average LOS : • admitted consumers is 6 hrs 30mins • non admitted consumers is 4 hrs 20 mins % of consumers departing to a MH bed: • within 4 hours is 36% • within 8 hours is 62% Consumers discharged within 4 hours is 62% 7.6% of all ED presentations are drug and alcohol related. • 40% are from outside the STV catchment area Page 8
  9. 9. Mental Health Patient Flow The main reason for delays from ED to a MH bed is access to beds, in particular HDU beds followed by the need for further medical assessment/treatment Day/Month/Year Footnote to go here Page 9
  10. 10. Other factors  In patient average LOS is 12 days with long stay consumers over 35 days - 32%  Short lengths of stay and the need to make room for new admissions mean that the “least” unwell being discharged  Occupancy on average 93%, only one unit  Out of area admissions are between 20-30%  HDU beds are always full-pressure from inside and outside, constant juggle, some patients moved 3-4 times throughout their stay  Patient flow in and out of the In Patient Unit is the key to ensuring flow from ED Day/Month/Year Footnote to go here Page 10
  11. 11. So what is the answer to these challenges? Day/Month/Year Footnote to go here Page 11
  12. 12. A whole of system approach is needed Day/Month/Year Footnote to go here Page 12
  13. 13. Whole of service approach includes: • Community teams • CL team • Inpatient team • ED teams • Broader health service Day/Month/Year Footnote to go here Page 13
  14. 14. What we are doing Communication process to create an understanding in mental health bed management and patient flow:  Education around MH admissions and discharge- flow of consumers across the continuum of care via daily update which includes:  admissions and discharges in last 24 hours and those planned  patients in ED and current status  patients waiting in community or other hospitals  patients waiting in a general bed  high and low dependency vacancy break down  Any issues on the In-patient Unit Creates transparency and understanding and ensures that pertinent information is communicated and challenges in mental health are understood Day/Month/Year Footnote to go here Page 14
  15. 15. What we are doing  Admitting Officer role  Acute Care Transition Coordinator-discharge focus, contacts Case Manager or primary care on admission, sends request for community supports to attend clinical meetings etc  Role of community case managers  ED MH clinicians, psychiatric triage, CAT clinicians Day/Month/Year Footnote to go here Page 15
  16. 16. What we are doing • Extended Triage • MH HARP • Escalation process if discharge delayed for ED • Daily review of all ED and Psychiatric Triage presentations Day/Month/Year Footnote to go here Page 16
  17. 17. What we are doing  Weekly review of service integration and collaboration (MH, ED, ALERT)  Working with Police and Ambulance  Admitting to Mental Health beds straight from Community Day/Month/Year Footnote to go here Page 17
  18. 18. What we are doing  Increased resources for treatment of drug and alcohol presentations  Productive Mental Health Ward project  Increased access to SECU Page 18
  19. 19. Has anything changed? Day/Month/Year Footnote to go here Page 19
  20. 20. Yes it has – a bit January 2014 Average LOS in ED :  admitted consumers is 5 hrs 48mins (was 6 hrs 30 min)  non admitted consumers is 4 hours 6 mins (was 4 hrs 20 mins) % of consumers departing to a MH bed:  within 4 hours is 53% (was 36%)  within 8 hours is 77% (was 62 %) Consumers discharged within 4 hours is 62.3% (was 62%) Day/Month/Year Footnote to go here Page 20
  21. 21. The future  PARC development  Review of High Dependency beds  ? PAPU Day/Month/Year Footnote to go here Page 21

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