BRANT COMMUNITY HEALTHCARE SYSTEM Mental Health and Addiction Services Brant Community Healthcare...

BRANT COMMUNITY HEALTHCARE SYSTEMBRANT COMMUNITY HEALTHCARE SYSTEM

Mental Health and Addiction Services

Brant Community Healthcare System

November 2013

A Day Program is NOT a Day Hospital


Agenda

MH & A Services at the Brant Community Healthcare System in 2009

Change Catalyst

Goals

Definition

Acute Day Treatment Today

Challenges

Outcomes

Questions

BRANT COMMUNITY HEALTHCARE SYSTEMBRANT COMMUNITY HEALTHCARE SYSTEMMental Health and Addiction Services in 2009

Making It Happen Schedule 1 Facility

Crisis Services, including ER

Inpatient Services

Outpatient Services

Day Hospital

Consultation

MH & A Services programs For Brant, Haldimand, and Norfolk

24/7 ER nursing consultation, 5 day/week Urgent Care, and Crisis Intervention

18 bed Psychiatric short-stay stabilization

5 day/week Day program (0900 – 1430 hours); MH Counselling 5 days/week; and Vocational Program 5 days/week; Med Clinic 5 days/week

None

5 psychiatrists with priviledges

Community Treatment Order Co-ordinator


2009 Outcomes

Inpatient

19% increase in admissions over past 7 years d/t increase psychiatrists and population growth

Day Program

Averaged 9 Intakes/month; 7 service initiations/month

Vocational Program

Averaged 4 Intakes/month; 3 service initiations/month

Lengthy Community Agency waiting lists for support


Change Catalysts

In 2010, MH & A Services had to remove $500,000.00 from our budget. Programs that ‘should be in the community’ were the targets.

With the increase in psychiatric admissions, challenges with patient flow were occurring

Outpatient Service was focused on the less acute. Services were unable to assist with the more acute population.

LHIN priorities of reducing/diverting ER MH & A contacts and admissions

Community Agencies would not entertain providing anything more than support.


Our Goals

To move our services to Acute Care for both Inpatient and Outpatient programs

To continue to reduce our Inpatient Length of Stay

To enhance patient flow throughout the system

To incorporate the recovery model into our model of care

To create a system that assists with ER and Admission Diversion


What is a Day Hospital?Day Hospital is defined as a time-limited, ambulatory, active treatment

program that offers therapeutically intensive, coordinated and structured clinical services within a stable therapeutic milieu.

The program provides clinical diagnostic and treatment services on a level of intensity equal to an inpatient program, but on less than a 24-hour basis.

Day Hospital can be used both as a transitional level of care (i.e., step-down from inpatient) as well as a stand-alone level of care to stabilize a deteriorating condition and avert hospitalization. Treatment needs to focus on the individual's response during treatment program hours, as well as the continuity and transfer of treatment gains during the individual's non-program hours in the home/community.


Our Day Hospital – Acute Day Treatment Program

7 days/week

Clients typically come from 0930 – 1800 hours; staff available to clients from 0830 – 2030 hours

Consulting Psychiatrist that sees clients 5 mornings/week. On-call Psychiatrists are utilized after hours and weekends.

Interdisciplinary team of a Psychiatrist, Nursing, Social Work, Occupational Therapist and Recreation Therapist. Hospital staff rotate through Inpatient and Day Hospital Programs

Clients are admitted (Day Hospital Order Set). Orders are valid for 24 hours.

Unit is set up similar to Inpatient without beds (communication center, group rooms, lounge, kitchen area, interview rooms)


Day Hospital - continued

Clients receive individual and group therapy, medication adjustments and monitoring, diagnostic investigation

Clients prepare lunch. This allows us to incorporate budgeting, grocery shopping, food preparation and storage, and clean up into treatment model. Supper is through the hospital meal system.

Addiction Services does provide a group a week.

Follows a Recovery Model. Maximum length of service is 28 days. Individuals may then be admitted to a Middle Recovery Evening Program.

EPI utilizes Day Hospital for more acute cases to divert admission


Challenges

Education

• A Day Hospital is not a Day Program

• Limiting admission access

Changing outpatient culture

• Increasing outpatient staff skills to provide service to a more acute population. All disciplines perform MSE and integrate assessment outcome into interventions.

• Letting go of the ‘Intake’ mindset

• Work hardening to 12 hour tours

Changing community culture

• Decrease hospital option for ‘worried well’


Admission Sources


Outcomes

•Continued increase in inpatient admissions since 2009 (14%). 22% of these admissions are <24 hours – which move to Day Hospital

•Our Inpatient LOS has gone from 6.8 to 6.54 days

•We are currently average 21 admissions/month (target is 19) with 17 service initiations

–22% are from our Crisis (ER and outreach)

–33% are from the Inpatient Unit

–45% are directly from Psychiatrists


Outcomes - continued

Average wait time from admission order to assessment is 6.46 hours (this includes off-hour admission orders received)

Average engagement rate of 81%

Average length of service is 18.03 days

Average ER contacts/month is 1.29; average admissions/ month is 1.43

BRANT COMMUNITY HEALTHCARE SYSTEM Mental Health and Addiction Services Brant Community Healthcare...

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