EMERGENCY DEPARTMENT DIVERSION (EDD) PROJECT

Transcription

1 EMERGENCY DEPARTMENT DIVERSION (EDD) PROJECT AN INTEGRATED RESPONSE TO MENTAL HEALTH PATIENTS PRESENTING IN HOSPITAL EMERGENCY DEPARTMENT NORTH YORK GENERAL HOSPITAL * SAINT ELIZABETH HEALTH CARE * ACCESS ONE PARTNERS (COTA COTA HEALTH, BAYVIEW COMMUNITY SERVICES & TORONTO NORTH SUPPORT SERVICES)

2 BACKGROUND - EDD GOAL: to facilitate the development and implementation of evidence-based system improvement models and/or activities, which result in reduced wait times and shorter length of stay in the Emergency Department. One-time grant funded by the MOHLTC Intended to support collaborative projects between the acute care and non-acute care sectors Have potential for transferability of outcomes Be self-sustaining after pilot completion

3 ISSUES Many clients seek assistance in ED due to: lack of alternative avenues for support their community support services are not accessible. When individuals in ED cannot be discharged quickly and safely they either: wait and are monitored in ED are admitted to an inpatient bed This adds to already overcrowded ED waiting rooms and shortage of inpatient beds.

4 THE EDD PROJECT Provides a quick response to individuals presenting in the ED at NYGH who are experiencing mental health related crises,, and who can be supported safely in the community. Facilitates a seamless continuum of care for clients. Provides an alternative to admissions to an inpatient bed or to an extended wait in the Emergency Dept. until safety can be assured Improves access to and knowledge of community-based services for this population. Expands the knowledge and skills of staff within this partnership agreement. Provides a model of collaboration and effective use of shared resources.

5 TARGET POPULATION: Individuals being held in the ED due to safety concerns and a lack of appropriate support resources in community. Individuals that have supports in the community but they are unable to access them. Individuals having multiple visits to the ED in a short period of time Frequent visitors to ED where the pattern has accelerated or changes noted

6 EXCLUDED POPULATION Any person under the age of 16. Primary Axis 1 Diagnosis of eating disorder, developmental delay or substance abuse. Delirium, dementia (with aggression) or presence of acute medical illness Substance induced psychosis Current forensic charges and/or risk of violence (forensic involvement to be explored further) Anyone at high risk of suicide

7 Service Flow EDD Diversion NYGH crisis nurse assesses if client is appropriate for EDD Program ram Assessment by the Community Crisis Worker in ED within 90 minutes Development of a community support plan ensuring that safety concerns cerns are addressed Community support plan could include: - brief telephone or mobile support by SEHC crisis team - intensive crisis management by SEHC crisis management team - short-term term case management services through Access One partner agencies (Toronto North Support Services, COTA Health, Bayview Community Services) Hospital Discharge plan for day program, psychiatrist appt, MH clinicc

8 Evaluation Metrics EDD s impact on: the clients served the hospital s s Emergency Department (ED) and Mental Health (MH) programs All NYGH ED patients referred to the EDD Program from May 2007 to March 2008 and seen by the SEHC Community crisis worker were eligible to participate in the evaluation.

9 EDDP Patient Statistics Patients Referred to EDDP: : 85 Gender: : 65.9 % Female Age Range: years old Age Median: 36.5 years old Clients Served by CCW in the Community: 64 (75.3%) Average Days Served by Crisis Program: 17.6 days Clients Referred to Access One: 12 (14.1%)

10 Age Distribution of EDD Clients 10% 7% 13% 24% 25% 21% yrs yrs yrs yrs yrs 60+ yrs

11 Summary of System Outcomes Admissions and Repeat Visits: Over half of patients referred to EDD may have been admitted to inpatient bed had EDD services not been available* 76.5 % of patients had no return visits (compared to 44.4% with return visits pre-edd) 83.3% clients said they would seek alternate services than ED if another MH crisis occurred. * At rate of $ cost/patient day and estimated 3 day LOS, results in potential cost savings of over $40,000

12 Summary of System Outcomes Client Outcomes: 63.3% of clients reported they were unaware of community crisis services prior to being referred to EDD Program 83.3% of clients referred to Crisis Management service reported this service helped them meet their goals 83.3% reported feeling better prepared to deal with daily problems Higher percentage of clients followed through with hospital discharge plan (antecdotal( accounts) Overall, less than 10% of clients were referred on to longer term case management services indicating the strength of the crisis stabilization model of care

13 Summary of System Outcomes Client Satisfaction: 83.3% reported being satisfied with the services they received in the ED 83.3% felt that they received prompt service by the CCW 83.3% reported that the quality of care and services they received in the community were good to excellent Over 75% found the envelope of care they received through the EDD Program helpful

14 Limitations of the Evaluation Small sample size 25% of clients found Difficulty contacting clients post discharge from EDD Limited comparative data Note: New wait time indicators for Emergency Departments may assist future data collection and evaluation

15 LESSONS LEARNED Data collection type of statistics around Length of Stay in ED skewed some of the results. (Example: Length of stay in ED started with ED registration and stopped when left hospital should have stopped when referred over to the EDD Program) Exploration and implementation of service refinements (e.g., client can either continue to meet with CCW in hospital or return home and seen that day for community support assessment) Potential expansion of the program to serve more MH patients (less exclusionary criteria) On-going education and training of front-line staff regarding the service (especially relief)

16 Conclusions The EDDP has helped to build mutual trust between the participating organizations. The service delivery system between hospital and community is now reacting in a more effective and responsive manner Low Cost Delivery to operate program Positive impact on both the clients served and savings to the system. Project sustained and operational there are some limitations to current operations as previous central coordination is no longer in place and this has impacted on service flow. Additional funding is required to address service refinements and enhance service operations

17 FOR INFORMATION REGARDING THE EMERGENCY DEPARTMENT DIVERSION PROGRAM, CONTACT: SAUL GOODMAN PROGRAM DIRECTOR MENTAL HEALTH NORTH YORK GENERAL HOSPITAL MARY COMPTON MANAGER OF CRISIS SERVICES SAINT ELIZABETH HEALTH CARE EXT

18 THIS INITIATIVE WAS DEVELOPED AND INITIATED THROUGH ONE TIME FUNDING FROM THE MINISTRY OF HEALTH AND LONG TERM CARE EMERGENCY DEPARTMENT SUPPORT FUND