Psychiatric Crisis and Emergency Response System

Page 1

Franklin County Psychiatric Crisis and Emergency System (PCES) Task Force


Why create the PCES task force? Escalating community need Increase in med/surge referrals Overcrowding in ERs Medicaid expansion Other payment reform


Volume by Month: FCBB Reports

3


Task force representation ADAMH Franklin County

Nationwide Children’s Hospital

Central Ohio Hospital Council

Ohio Department of Mental Health

Central Ohio Trauma System

Twin Valley Behavioral Health

The Columbus Foundation

Ohio Hospital for Psychiatry

Columbus Springs

Ohio Health

Maryhaven

OSU Wexner Medical Center

Mount Carmel West

Osteopathic Heritage Foundation

National Alliance of Mental Illness

Primary One Health

Netcare Access


Goals 

Increase access to patient-centered mental health and addiction-related crisis services and expand intermediate and ambulatory care options

Decrease utilization of emergency departments and inpatient services and reduce the length of stay of psychiatric patients in emergency rooms

Ensure equitable patient care regardless of payor source PCES


Recommendations

1 PCES

Create a comprehensive, collaborative system of crisis care for individuals experiencing mental health and/or addiction emergencies.


Recommendations

2

Identify and develop additional options for intermediate and ambulatory care for individuals in need of mental health and/or alcohol and drug addiction treatment. • Expand role of community mental health centers (pilot program) • Increase the use of crisis action teams, mobile crisis teams, and telepsychiatry.

PCES


Recommendations

3

Build collaborative, effective working relationships with the payor community to favorably encourage an improved model which ensures that patients receive access to high quality care in a cost-efficient manner. • Foster positive, productive relationships with payors • Work to eliminate barriers to treatment for patients in freestanding facilities

PCES


Recommendations

2

Pilot: Linkages between Grant Medical Center ED and Southeast Inc.  Southeast

clinician is housed at the Grant ED between 10 a.m. and 2 p.m. on Saturdays and Sundays.

 Clinician

can access the patient’s clinical information and has the ability to do real-time scheduling.

Results: 33% decrease in the average time to disposition for patients seen by Southeast clinicians. PCES


Recommendations

3

Pilot: Telepsychiatry consult in EDs where psychiatric services are not available 

OhioHealth: Average length of stay for psychiatric patients in Doctors ED reduced by 26%.

ALOS for psychiatric patients in the ED who were admitted to an inpatient psychiatric unit was reduced by 28%.

Number of patients admitted to an inpatient unit decreased 10%. Patients discharged home instead of admitted to an inpatient unit

PCES


Feasibility of Centralized and Collaborative System of Care ď ľ The

goal is to provide a report to inform the PCES Task Force of models of care that can ensure the right level of care as quickly as possible for behavioral health patients

PCES


Mixed Methods Approach to Develop Models of Care Delivery  Literature  Key

Review

Informant Interviews

 Focus  Data

Group and Expert Panel

Analysis from Franklin County Hospitals

PCES


Model 1: Franklin County Behavioral Health Emergency Facility Model Overview  Bricks and mortar behavioral health emergency facility 

Linked EHR

EMS triage on-site before transfer to facility

Law Enforcement/Social Worker response team

Case managers/social workers to improve community linkages

Medicaid reimbursement code activation PCES

Highlights  Emergency facility specifically for behavioral health patients with varying levels of care 

EHR interoperability to more rapidly share information

Specialized response units to deescalate and better assess behavioral health needs

Increase connectivity to community resources and improve follow-up rates


Logic Model 1: Behavioral Health Emergency Facility Inputs Structural: Facility Transport Office space for community resources Funding

PCES Personnel: Behavioral Healthcare personnel


Logic Model 1: Behavioral Health Emergency Facility Activities

Structural: Construction of facility Create transport protocol for patient transport/transfers Carry out fundraising efforts

Personnel: PCES

Hiring BH providers


Logic Model 1: Behavioral Health Emergency Facility Outputs

Structural: BH Emergency Facility # of offices for community resources $ raised for facility Finalized protocol for transport/transfers

PCES

Personnel: # of BH providers hired


Logic Model 1: Behavioral Health Emergency Facility Outcomes Health: Decrease ED visits for BH Decrease BH inpatient admissions Decrease minutes waiting in ED Decrease days BH inpatient stay Decrease hours of ED on divert Decrease hours of physical restraint

Community: IncreasePCES discharges to community Decrease BH-related incarcerations


Model 2: Behavioral Health Electronic Hub Model Overview  EHR Interoperability and information sharing is critical 

Current facilities remain with inter-connectivity to alert providers to patients in need of services EMS and Law Enforcement Training still needed Increased availability for outpatient resources needed

PCES

Highlights  Care coordination staff will be responsible for monitoring electronic system 

Care coordination notifies appropriate site/provider for availability of services for patient

EMS and Law Enforcement to deescalate and manage on-site, can notify care coordination is services needed


Logic Model 2: Behavioral Health Electronic Hub Inputs Structural: Transport Office space for Care Coordinators Funding

Personnel: PCES

Behavioral Healthcare personnel


Logic Model 2: Behavioral Health Electronic Hub Activities Structural: Dedicated office space for care coordination Create transport protocol for patient transport/transfers Identify funding sources

Personnel: PCES Hiring BH providers


Logic Model 2: Behavioral Health Electronic Hub Outputs Structural: # of offices for care coordination Finalized protocol for transport/transfers $ allocated for system

PCES Personnel: # of BH providers hired


Logic Model 2: Behavioral Health Electronic Hub Outcomes Health: Decrease ED visits for BH Decrease BH inpatient admissions Decrease minutes waiting in ED Decrease days BH inpatient stay Decrease hours of ED on divert Decrease hours of physical restraint

Community: IncreasePCES discharges to community Decrease BH-related incarcerations


Group Breakouts 

Review the proposed logic models for the model assigned to group

Keep in mind that these are simplified, highlevel representations of the model

Consider additional components needed for consideration or components to be removed

Fill in blank logic model sections with additional components

PCES


Questions

PCES


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