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Quality team day slideshow 2010 taliaferro

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  • 1. Transforming the Concept,Process & Environment of
    Jim Taliaferro CMHC Admission & Evaluation Services Unit
  • 2. Introduction
    The Jim Taliaferro Community Mental Health Center Triage Unit was established in early 1990 and is now referred to locally as the “Admission and Evaluations Services Unit”. This unit provides consumer screening for mental health issues, substance abuse services, and provides timely crisis interventions for all Oklahomans in our nine county catchment area in Southwest Oklahoma. The mission of Admission Services is to complete evaluations for all consumers presenting to JTCMHC to determine a diagnoses and assess the type of service that can be provided by our facility to the consumer.
    Our Coverage Area
    CIMARRON
    TEXAS
    BEAVER
    WOODS
    OTTAWA
    HARPER
    OSAGE
    KAY
    GRANT
    NOWATA
    WASHINGTON
    CRAIG
    ALFALFA
    ELLIS
    WOODWARD
    GARFIELD
    NOBLE
    DELAWARE
    MAYES
    ROGERS
    MAJOR
    PAWNEE
    TULSA
    PAYNE
    KINGFISHER
    DEWEY
    BLAINE
    WAGONER
    CREEK
    CHEROKEE
    LOGAN
    LINCOLN
    ADAIR
    ROGER MILLS
    MUSKOGEE
    CUSTER
    OKMULGEE
    OKLAHOMA
    SEQUOYAH
    CANADIAN
    OKFUSKEE
    McINTOSH
    BECKHAM
    CADDO
    WASHITA
    POTTAWATOMIE
    SEMINOLE
    HASKELL
    CLEVELAND
    HUGHES
    GRADY
    KIOWA
    GREER
    PITTSBURG
    McCLAIN
    LEFLORE
    LATIMER
    PONTOTOC
    HARMON
    GARVIN
    COMANCHE
    JACKSON
    COAL
    STEPHENS
    TILLMAN
    MURRAY
    PUSHMATAHA
    JOHNSTON
    ATOKA
    CARTER
    COTTON
    JEFFERSON
    McCURTAIN
    CHOCTAW
    MARSHALL
    LOVE
    BRYAN
  • 3. The Challenge
    During the 2009 fiscal year, a severe shortage of physicians made it necessary to admit all consumers presenting to Inpatient under ED status after 5:00 pm daily, as there was no physician available to evaluate them until the following morning. This, in turn, produced an unacceptable number of admissions with stays of less than 24 hours, bringing down the average length of stay from 4-5 days to just 2 days. Because the timeframe for completing all assessments and the interdisciplinary treatment plan is determined by the average length of stay, when we were surveyed in 2008 by Center for Medicare and Medicaid Services (CMS) we were required by them to change our policy and to complete all assessments and treatment plans in just 48 hours instead of the usual 72. This change made it necessary to have social workers on site 7 days a week, and even so, the 48 hour deadline was not consistently being met, placing our CMS certification in jeopardy.
    $ 1,000,000
    In Funding in
    Jeopardy
    No Physician
    Coverage
    The initial purpose of this project was to eliminate the need to admit consumers who did not meet ED criteria and hopefully to return to our pre-crisis average length of stay.
    Cost Overruns
    Because of
    Bad ED
    Admits
  • 4. The Team
    A team comprised of directors and coordinators was designated by our Facility Executive Director to address these issues and provide an economical solution.
    Jim Regan Executive Director
    Mike Strickland, MD Clinical Director
    Judy Wallace, Process Improvement
    Victor Wilkerson Inpatient Director
    Ellie Cruz, RN Director of Nursing
    Jill Melrose Evaluations Unit Coordinator
    Randy Kauk Senior Evaluation Specialist
  • 5. Our Goals
    A team comprised of directors and coordinators was designated by the Facility Executive Director to address these issues and provide an economical solution with the following goals:
    Reduce crowding, wait times, and the number of patients who leave without being seen
    Improve the Emergency Detention Admission Process to provide better integration with Law Enforcement Agencies
    Create a staffing plan that reduces costs and increases coverage during peak hours.
    Develop call-coverage strategies and closer alignment with key physicians
    Provide better patient and staff safety while increasing overall program satisfaction
    Expand and remodel the Evaluation Unit
    Provide comfort rooms to consumers and law enforcement personnel to make any wait times more tolerable
  • 6. Methods
    To accomplish the objectives the Facility Executive Director put before the team the PDSA3 (Plan, Do, Study, Act) model was utilized. Admission and length of stay data from the inpatient unit was collected and compiled for a 6 month time frame to establish trends and peak admission times for each day of the week. It became immediately apparent that by eliminating admissions released immediately after evaluation, the average length of stay would return to pre-crisis levels. It was also determined that by locally adjusting staffing level to the unit would save our facility approximately $230,000 in payroll. Additional cost savings would also be realized from the decrease in frivolous admissions thus reducing overall operational cost in our inpatient unit.
    PDSA3 Model
    $230k+ in
    Payroll Saved!
    Reduced
    Operating
    Cost
    Total CMS
    Compliance!
  • 7. Methods
  • 8. The Solution
    The new
    jimtaliaferrocmhc
    Admission & evaluation services unit
  • 9. How it works
    1. Consumer is transported to our facility.
    JTCMHC recognizes the importance of mutual respect and cooperation between our staff and law enforcement, and we make every effort to extend our “warm and welcoming” attitude towards our law enforcement officers as well as our consumers. They are made to feel welcome from the moment they drive into our parking lot with their own designated parking spaces “front and center”.
    The redesign of our Evaluation Services Unit has resulted in a new entrance for law enforcement. The old design made it necessary for the officers to enter with consumers through a side door which opened directly onto the Inpatient Unit.
  • 10. How it works
    Adding to the sense of home-like tranquility, at the entrance to the Evaluations Unit is a bright and cheery kitchen for preparing coffee, beverages and nourishments for our guests.
    Proceeding down the hallway just beyond the kitchen are locked cubbies where law enforcement officers can store their guns. Just around the corner and next to the water fountain is an on-site bathroom which eliminates any need for consumers awaiting evaluation to have to leave the Unit until such time as they are admitted or released.
  • 11. How it works
    2. They are welcomed to our newly remodeled Admissions & Evaluations Unit
    On the new Unit, confidentiality is maintained and the consumer does not enter the Inpatient Unit unless admitted.
    Our new “comfort room” is a welcoming safe haven for consumers as they await evaluation. The pull-out sleeper chairs are stocked with pillows and blankets under the seats and the adjustable lighting creates a warm and relaxing oasis.
    (Simulated consumer)
  • 12. How it works
    Law Enforcement &
    Department of Corrections
    are
    WELCOME
    Here again, we are pampering our law enforcement officers in their own comfort room as they wait for consumers to be evaluated. The room is right next to the consumer’s comfort room and will soon have a one-way observation window on left wall so that the officers can observe their charges. Refreshments are available, as well as reading materials.
  • 13. How it works
    3. Consumer is evaluated, and if criteria is met, admitted by friendly and concerned staff.
    This is one of three triage offices where our evaluations take place and one of our wonderful triage staff. They all take pride in making their offices warm and inviting.
    (Simulated consumer)
  • 14. Results
    Enhanced
    Quality of
    Care
    Decreased
    E.R. & Jail
    For Consumers
    48%
    More M.H. Beds
    Available
    No Adverse
    Treatment
    • Stays of < 24 hours cut in half
    • 15. Increased ALOS from 2-3 days to 4-5 days
    • 16. Decreased wait time for evaluations
    • 17. Increased consumer satisfaction
    • 18. Improved relations with law enforcement
    • 19. Improved staff morale
    • 20. 27% decrease in < 30 day readmissions
    $230k+ in
    Payroll Saved!
  • 21. Costs and Returns
  • 22. On 8/10/2009 we received a call from Jackson County hospital after
    normal business hours for an evaluation of a 55-year-old woman who
    had been admitted for uncontrollable blood pressure and low oxygen
    levels. She had to be constantly monitored at the hospital because of
    her unstable medical condition. She was complaining of voices telling
    her to kill herself. Over the course of her hospital stay, her mental
    state had cleared, but her doctor would not release her without a
    psychological evaluation. The Evaluation Unit decided to provide the
    evaluation at our satellite office in Altus with a Licensed Mental Health
    Professional in Lawton via video conference. This would save the
    fragile lady with oxygen tanks from making a three hour trip to Lawton in the custody of a police officer. (Law Enforcement was also interested in this solution as it would be saving them time and money.) The woman was evaluated via video conference and was found to no longer have hallucinations or any suicidal intent, nor did she meet criteria for an inpatient admission to our facility. This was our center’s first Psychological Evaluation via video conference. Both the police and the hospital in Altus have asked for a meeting on the new possibility of remote evaluations because of the convenience, cost savings, and reduction in further trauma to their consumers.
    Success Story
    Hope
  • 23. Where to from here?
  • 24. Thank You !

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