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Bridget Organ, Manager Mental Health, St Vincent’s Melbourne delivered this presentation at the 2014 Hospital Bed Management & Patient Flow Conference, Australia's foremost patient flow improvement meeting, showcasing innovative case studies and pioneering best practice in the nation’s hospitals. Over 150 hospitals and state and federal departments of health throughout Australia and New Zealand have attended this conference over the past years. For more information about the annual event, please visit the conference website: http://www.healthcareconferences.com.au/bedmanagement14
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Managing the Demand of Mental
Health Consumers in ED
Bridget Organ
Manager Mental Health
Page 2
St Vincent’s Mental Health
Catchment covers the City of Yarra and Boroondara with a combined
population of 240,000
An adult service which is predominantly community based providing
acute community based assessment and treatment, case
management, residential rehabilitation, homeless outreach and
Psychiatric Triage and Emergency Department services
Regional eating disorders day patient program
44 bed in-patient unit (5 Aboriginal beds)
State-wide and regional services
Aged Persons Mental Health Service
Background
Acute In-Patient Service
Page 3
St Vincent’s Hospital
Day/Month/Year Footnote to go here Page 4
St Vincent’s Melbourne provides
medical and surgical services,
sub-acute care, aged
care, correctional health, mental
health and a range of community
and outreach services. St
Vincent’s employs more than
5,700 staff and has 880 beds and
one of the busiest Emergency
Departments in Victoria.
.
There are approximately 42,000 presentations to ED annually, one third is admitted and 2 thirds not
admitted
Page 5
Data
Page 6
ALERT (Care Coordination for people with complex needs in the ED), Addiction medicine.
Mental health services:
Psychiatric triage 24/7
Extended triage 7 days/week
ED Mental Health (ECAT) 24/7
Services in ED
Mental Health
On average per month there are:
• 325 MH presentations per month to ED
• 9% are brought to ED by Police; 56% by Ambulance
• 30 consumers admitted per month via ED
• Psychiatric triage receives on average 900 calls per month
Page 7
Data
Average LOS :
• admitted consumers is 6 hrs 30mins
• non admitted consumers is 4 hrs 20 mins
% of consumers departing to a MH bed:
• within 4 hours is 36%
• within 8 hours is 62%
Consumers discharged within 4 hours is 62%
7.6% of all ED presentations are drug and alcohol related.
• 40% are from outside the STV catchment area
Page 8
Data May 2013
The main reason for delays from ED to a MH bed is access to beds, in particular HDU beds followed by the need for further medical assessment/treatment
Day/Month/Year Footnote to go here Page 9
Mental Health Patient Flow
Day/Month/Year Footnote to go here Page 10
Other factors
In patient average LOS is 12 days with long stay consumers over 35 days - 32%
Short lengths of stay and the need to make room for new admissions mean that the “least” unwell being discharged
Occupancy on average 93%, only one unit
Out of area admissions are between 20-30%
HDU beds are always full-pressure from inside and outside, constant juggle, some patients moved 3-4 times throughout their stay
Patient flow in and out of the In Patient Unit is the key to ensuring flow from ED
So what is the answer to these challenges?
Day/Month/Year Footnote to go here Page 11
A whole of system approach is needed
Day/Month/Year Footnote to go here Page 12
Whole of service approach includes: • Community teams
• CL team • Inpatient team
• ED teams • Broader health service
Day/Month/Year Footnote to go here Page 13
Day/Month/Year Footnote to go here Page 14
What we are doing
Communication process to create an understanding in mental health bed management and patient flow:
Education around MH admissions and discharge- flow of consumers across the continuum of care via daily update which includes:
admissions and discharges in last 24 hours and those planned
patients in ED and current status
patients waiting in community or other hospitals
patients waiting in a general bed
high and low dependency vacancy break down
Any issues on the In-patient Unit
Creates transparency and understanding and ensures that pertinent information is communicated and challenges in mental health are understood
What we are doing
Admitting Officer role
Acute Care Transition Coordinator-discharge focus, contacts Case Manager or primary care on admission, sends request for community supports to attend clinical meetings etc
Role of community case managers
ED MH clinicians, psychiatric triage, CAT clinicians
Day/Month/Year Footnote to go here Page 15
What we are doing
• Extended Triage
• MH HARP
• Escalation process if discharge delayed for ED
• Daily review of all ED and Psychiatric Triage presentations
Day/Month/Year Footnote to go here Page 16
Day/Month/Year Footnote to go here Page 17
What we are doing
Weekly review of service integration and collaboration (MH, ED, ALERT)
Working with Police and Ambulance
Admitting to Mental Health beds straight from Community
Page 18
Increased resources for treatment of drug and alcohol presentations
Productive Mental Health Ward project
Increased access to SECU
What we are doing
Has anything changed?
Day/Month/Year Footnote to go here Page 19
Yes it has – a bit
January 2014
Average LOS in ED :
admitted consumers is 5 hrs 48mins (was 6 hrs 30 min)
non admitted consumers is 4 hours 6 mins (was 4 hrs 20 mins)
% of consumers departing to a MH bed:
within 4 hours is 53% (was 36%)
within 8 hours is 77% (was 62 %)
Consumers discharged within 4 hours is 62.3% (was 62%)
Day/Month/Year Footnote to go here Page 20
The future
PARC development
Review of High Dependency beds
? PAPU
Day/Month/Year Footnote to go here Page 21
