Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center at Wishard Health Services, describes how a daily conference call can streamline the coordination of care within a psychiatric ED.
Our daily conference call allows people across the system to call in and coordinate care. We focus the call on all patients currently utilizing acute care services, to ensure that they receive the appropriate level of care. Facilitated by our medical director, the call is limited to 30 minutes and, utilizing a bed huddle concept, includes approximately 23 of our programs across the city.
We begin each call by quickly reviewing all patients currently in the psychiatric ED. By requesting assistance from the outpatient area that serves the patient, we can get immediate coordination of their care and make decisions concerning disposition on the spot. Our crisis intervention unit — the 24-hour walk-in clinic that consults with both our medical ED and our hospital consult service — then assigns staff to any patient currently in their clinic or in the medical hospital that needs services. They coordinate and assist with patient disposition. We SAPped any discharges that could be implemented from the inpatient services, which allowed our staff to get the necessary appointments with the outpatient provider, immediately reducing the previous phone tag.
The expectation for each outpatient clinic site was that they would report on any patient within the acute care services system, with emphasis on patient movement and coordination throughout the system. Our initial goal was, “admissions must equal discharges.” It was the expectation that we would keep services open for people who needed acute services. For example: if we had three patients needing inpatient admission but our facilities were at capacity, we would all work to find space for them. We would figure out a way to make the admissions equal to the discharges. All levels of leadership participate in these calls as well, which allows for teaching and creative problem-solving within difficult clinical situations. An emphasis is placed on patients whose names frequently come up, who may need interventions that we had not tried.
Accountability has increased center-wide as a result of the daily conference calls. When oversights occur, it is clear to everyone involved and corrections can immediately be made. We quickly identified barriers to patient care through these calls and learned that the vast majority of barriers were within our own system; we were the ones creating our own problems. Most organizations have long-standing myths about the way things are done in their organizations. During conference calls, we can dispel these myths in real time, while we’re talking about the kind of care we can best provide to the clients.
Source: Emergency Room Triage of the Mental Health Patient: Pilot Projects in ED Diversion, November 2008
Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion
In this special report, one industry expert explains how the community mental health center's system-wide daily conference call helps to balance work and patient flow, encourages creative problem-solving and dramatically reduces staff time spent on diversion of psychiatric ER patients to other facilities. A second expert describes a pilot program placing a psychiatric nurse in the ED, along with the impact of the program on hospital admits, discharges and resource allocation, and ED staff satisfaction and morale.
Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion is available from the Healthcare Intelligence Network for $107 by visiting our Online Bookstore or by calling toll-free (888) 446-3530.
