Jim Taliferro CMHC Quality Team Day 2010 Application
2007870130175<br />Transforming the Concept, Process and Environment of the Jim Taliaferro CMHC Evaluation Services Unit<br />Quality Team Day Project Submission <br />Jim Taliaferro Community Mental Health Center<br /><602 S.W. 38th Street, Lawton, Oklahoma 73505<br />Team Members<br />Jim Regan, Executive DirectorJim Taliaferro CMHC(580) 248-5780 email@example.comMike Strickland, MDClinical DirectorJim Taliaferro CMHC(580) 248-5780 firstname.lastname@example.orgJudy Wallace, QA/PIJim Taliaferro CMHC(580) 248-5780 email@example.comVictor Wilkerson, Director of Inpatient ServicesJim Taliaferro CMHC(580) 248-5780 firstname.lastname@example.orgEllie Cruz, Director of NursingJim Taliaferro CMHC(580) 248-5780 email@example.comJill Melrose, Evaluation Services CoordinatorJim Taliaferro CMHC(580) 248-5780 firstname.lastname@example.orgRandy Kauk, Triage SpecialistJim Taliaferro CMHC(580) 248-5780 email@example.com<br />Abstract Summary (125 words)<br />Jim Taliaferro Community Mental Health Center utilizes modern process improvement techniques with creative planning and hard work to enhance the quality and cost effectiveness of its Evaluation Services Unit in such a way as to eliminate inappropriate admissions and increase the length of stay by patients to its inpatient unit. This role change reduced crowding, wait times, and provided better integration with Law Enforcement Agencies by creating a staffing plan that reduces cost and increases coverage during peak admission hours while providing better patient and staff safety and increasing overall consumer and employee satisfaction.<br />Background Introduction<br />The Jim Taliaferro Community Mental Health Center Triage Unit was established in March 1998 and is now referred to locally as the “Evaluation 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.<br />Problem/Purpose<br />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 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. 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.<br />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:<br /><ul><li>Enhance the quality and cost effectiveness of our services to our consumers by changing the role of our evaluation services unit in such a way as to eliminate inappropriate admissions and increase the length of stay by patients in our inpatient unit.
Reduce crowding, wait times, and the number of patients who leave without being seen.
Improve the Emergency Detention admission process and provide better integration with Law Enforcement Agencies and our Inpatient Unit.
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 satisfaction.</li></ul>Methods<br />To accomplish the objectives the Facility Executive Director put before the team the PDSA3 (Plan, Do, Study, Adopt, Adapt, or Abandon) 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 (see graph). 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 $250,000 in payroll by reducing the immediate need for adding another physician. Additional cost savings would also be realized from the decrease in frivolous admissions thus reducing overall operational cost in our inpatient unit. Total projected savings to state payrolls and risk management for this project would save state agencies in excess of 10 million dollars over a 5 year time frame.<br />Options Considered but not implemented<br />Hire additional physicians<br /><ul><li>Hire additional LMHP staff</li></ul>Current Implementations<br /><ul><li>Allocation of additional space and remodel of the Triage Unit
Reallocation of available Licensed Mental Health Professionals (LMHP) to cover the staffing of the Triage Unit from 8 am through midnight.</li></ul>Future Recommendations<br /><ul><li>Expand Triage Unit coverage from midnight to 8 am
Implement evaluations via electronic video conferencing between local Emergency Rooms, Law Enforcement Agencies, and Court Houses and home based providers.</li></ul>Success Story<br /><ul><li>On 8/10/2009 we received a call from Jackson County hospital 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 Enhanced Evaluation Unit decided to provide the evaluation at our satellite office there in Altus with a Licensed Mental Health Professional here in Lawton via video conference. This would save the fragile lady with oxygen tanks from making on 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 and did not meet criteria for an inpatient admission to our facility. This was our centers 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 further reduced trauma to their consumers.