Emergency Psychiatric Assessment Team

Transcription

1 Emergency Psychiatric Assessment Team 1

2 Psychiatric Patients in Emergency Department In the state of Missouri and nationwide psychiatric admissions to Emergency departments have seen a steady and significant increase over the past 5-10 years Assessment and placement of psychiatric patients from emergency departments is one of the longest length of stays for emergency departments Boarding of psychiatric patients in emergency department rooms presents significant risks to patients and staff 2

3 Psychiatric Emergency Screenings To address these concerns Saint Luke s North Hospital (SLNH) implemented a Psychiatric Mobile Response Team in November 1997 The Psychiatric Mobile Response team screens all patients with psychiatric and substance abuse as the presenting or primary complaint in the Emergency department at the SLNH Barry Road and Smithville Campuses In 2005, with the opening of our newest hospital Saint Luke s East of Lee Summit, SLNH Psychiatric Mobile Response team has screened all psychiatric emergency patients. Due to the distance from SLNH, a separate psychiatric response team was implemented. However, staffing this team 24/7 for assessments a month was a challenge. In November 2009, we trialed the tele-psychiatry service, screening these patients with our SLNH team. SLNH Psychiatric Mobile Response Team is currently serving: SLNH Barry Road and Smithville, Saint Luke s East Hospital, Saint Luke s South Hospital, Saint Luke s Hospital of Kansas City (afterhours), Hedrick Medical Center (Chillicothe, Missouri) and Wright Memorial Hospital (Trenton, Missouri). 3

4 Psychiatric Mobile Response Team Personnel All Mobile Response Team personnel are Master s prepared Licensed Mental Health Professionals (Kansas and Missouri) Must have at least two years Mental Health experience Trained to perform Mental Health, Substance Abuse and Suicide Risk assessments EMTALA trained

5 Assessment Procedure 1. Patients are screened in the Emergency Department by ED physician and RN 2. If a patient is determined to have Psychiatric and/or Substance Abuse as primary complaint and patient is deemed medically stable/not requiring inpatient medical treatment, then 3. Emergency Department pages Psychiatric Mobile Response Staff 4. Mobile Response staff respond to page within 15 minutes and are available to screen patient within 45 minutes (goal is less than 30 minutes)

6 Assessment Process (cont.) 5. Mobile Response team confers with ED physician and nurse regarding patient s presenting complaints and current status 6. ED tech places Tele-medicine equipment in room 7. Mobile Response team calls into patient room and performs Mental Health/Substance Abuse/ Suicide/Homicide risk assessment. 8. Upon completion of assessment, Mobile Response confers with ED physician and nurse regarding recommendations

7 Assessment Process (cont.) 9. Mobile Response reviews recommendations with patient/family 10. For inpatient admissions, Mobile Response team consults with on-call psychiatrist to arrange for admission to an SLHS facility 11. For discharges, provides outpatient referral resources for patient follow-up 12. For patients requiring transfer to another facility/agency, will determine available services and arrange for transfer 13. Pre-certification of inpatient admission

8 Why Utilize SLNH Psychiatric Mobile Response Service Experience in working with Emergency Department staff and patients Knowledge of EMTALA issues related to psychiatric patients to prevent possible violations Qualified Mental Health professionals screening all patients Improved patient satisfaction for emergency psychiatric patients (patient working with mental health professionals) Improved Emergency Department staff satisfaction (psychiatric patients not a problem for Emergency Department personnel with Psychiatric team access)

9 Why Utilize SLNH Psychiatric Mobile Response Service (cont.) Improved access to other area mental health facilities for admission/transfers 24-hour access Mobile Response team experienced with handling psychiatric emergency conditions and working within a busy Emergency Department Continuity of working with area psychiatric providers, community mental health centers and other local area providers Strengthen the services available to communities with an integrated system

10 Cost for Services Equipment Cost: Purchase Tele-Medicine Equipment to be installed in Emergency Department (one-time fee estimated $12-15,000) Installation of Video drops in emergency department rooms (wireless technology is now available) Currently use Tanberg equipment but have capability to connect to other technology Connection will be encrypted to ensure confidentiality when outside of SLHS network Lease of equipment is possible Psychiatric Mobile Response Charge Monthly fee (two options) Set fee per month for set number of assessments per month, any assessment over set number of assessment additional cost No set fee, higher charge per assessment

11 Final Thoughts We can modify our assessment tool to meet your Electronic Medical Record References are available 2

12 Questions???