Transcript Document
Psychiatric Triage: Pilot put into Practice Presented by: Joe Eppling, RN, MN, MS, CRRN, CNAA, BC Director of Behavioral Health Services Health Care Crisis • Emergency Departments – – – – Increased utilization of ED Utilization of ED as primary care 12% increase utilization from 1994-2004 18% reduction of ED 1994-2004 • Psychiatric Service – – – – Decreased funding PPS Closure of inpatient and outpatient services Limited resources Health Care Crisis • Psychiatric Services in an ED – – – – – – Challenging environment Medical verses Psychiatric emergencies Perceptions of the mentally ill Presenting at increasing rates ED overwhelmed with influx of psych patients ED staff little or no training in mental health Location History • Mental health crisis no different for EJGH • More than 125 psychiatric beds closed between 1999-2004 • Closure of outpatient programs • Only 14 psychiatrists in the community and surrounding area History • According to the Agency for Healthcare Research and Quality – almost one-fourth of adult patients admitted in a community hospital is related to mental health or substance abuse Source: www.ahrq.gov (Released April 2007) Our Problem • Increased number of discharges < 24 hrs – 30% of total admissions through the ED • • • • • Inappropriate admissions through ED PEC patients from outlying hospitals Inpatient unit full Psychiatric diversion Patients being held in the ED Developing the Solution • Multidisciplinary Team Goals – Provide appropriate and timely care for mentally ill patients – Protect patients and staff from injury – Streamline current process for admission/transfer of psychiatric patients – Reduce the number of patients admitted less than 24 hours – Re-examine the role of the social worker – Protect the hospital from EMTALA violations Pilot • ED Psych nurse for Admission – – – – Perform assessments for inpatient need Receive orders Assist with admission Provide clinical info to insurance companies Pilot • ED Psych nurse for EMTALA calls – – – – – Gatekeeper Determine bed availability Receive clinical information Accept or deny transfers Coordinate transfers Pilot • ED Psych nurse for Diversion – – – – Assess for inpatient admission Find receiving facility Provide necessary clinical Assist with transfer to facility Pilot • ED Psych nurse for Discharges – – – – – Assess for non-admission Provide Outpatient resources Contact private insurance plans Make appointments Refer to MHC Costs • Projected costs – Salary of RN (4.2 FTEs) – Benefits • Actual costs – – – – 3.92 RN FTEs Benefits (14%) 11% overtime Orientation Savings • 1.6 FTEs of security hours • 330 Unnecessary admissions – Take cost of average day multiply by 330 Katrina and EJ Post Katrina • DHH findings 2005 Data – Mental illness and substance abuse most prevalent in uninsured populations – Serious mental health conditions one of the top five reasons for admission Source: http://www.dhh.louisiana.gov/offices/publications.asp?ID=288&Detail=1300 Post Katrina • Region 1 Inpatient psychiatric capacity – Pre Katrina 487 Psychiatric beds – Post Katrina 190 Psychiatric beds • Market share analysis for 2006 – EJGH 63% for psychiatric services • 2006 – 49,558 ED Visits – 6,951 Psychiatric visits (14%) Post Katrina Less than 24 hours (Admitted through our ED) Year Mental Illness Primary Diagnosis Substance Abuse Primary Diagnosis Patients PECd 2004 67% 33% 77% 10% 2005 75% 25% 75% 7% 2006 76% 24% 79% 10% 2007 88% 12% 69% 1.3% Outcomes Year Total Number of Standbys Actual Time in Hrs Average Time in Hrs 2004 749 3342 4.75 2005 613 2641 4.25 2006 815 5808 7.13 2007 658 4661 7.08 Outcomes Exceed Better Same Below Faster Assessments of Psych Patients 45% 55% 0% 0% Patient receive more appropriate psychiatric Care 20% 65% 15% 0% Appropriate ordering of psychiatric medications 20% 40% 40% 0% Less Restraint usage in ED 26% 37% 37% 0% Improved Communication Psych and ED nursing 53% 37% 10% 0% ED staff feeling supported by psych nursing 58% 42% 0% 0% Thank You [email protected] (504)454-4595