Presentation on theme: "Contact: Allan Abbass 902473-2514, firstname.lastname@example.org Emotion-based Assessment and Treatment of Patients with Repeat Unexplained ED Visits. 2010 Quality."— Presentation transcript:
1 Contact: Allan Abbass 902473-2514, email@example.com Emotion-based Assessment and Treatment of Patients with Repeat Unexplained ED Visits Quality Award Winner 2010 Accreditation Canada Leading PracticeAn Emergency Department and Centre for Emotions and Health CollaborationContact: Allan Abbass ,
2 Impact of Emotional factors in Capital Health Hospital DaysEmergency useMedical VisitsTests + ProceduresExcess MedicationsPoor OutcomesDisabilityMorbidityMortalityPhysical SymptomsPhysical IllnessesLow self careSelf InjuryRelationshipsLow ComplianceComplaintsEmotionDysregulation
3 Great Overlap Between Common Problems HeadacheConfusionIrritable BowelDyspepsiaAbdominal painBladder dysfunctionPelvic PainChemicalSensitivityFibromyalgiaFatigueHypertensionChest painPsoriasisDermatitisConversionPseudoneurologicalPhenomenaDepressionAnxietyPanic
4 Great Overlap Between Common Problems HeadacheConfusionIrritable BowelDyspepsiaAbdominal painEmotionDysregulationBladder dysfunctionPelvic PainChemicalSensitivityFibromyalgiaFatigueHypertensionChest painPsoriasisDermatitisConversionPseudoneurologicalPhenomenaDepressionAnxietyPanic
5 Unexplained Symptoms: Consecutive Referrals Nimnuan et al, 2001 Specialty% with 1 or more unexplained symptomsGynecology66Neurology62Gastroenterology58Chest Clinic51Rheumatology45Total52
6 Capital Health Excess Burden of Emotion-linked Medical Disorders Emergency use: ~15-20,000 visits/yrHospital Days: ~13,000 days per yearMedical Visits: 25-50% of all new consultsExcess Tests + Procedures: ?Excess Medications: ~$150,000/yr in HospitalSuboptimal Outcomes: ? CostExcess Side effects: ? Cost: many admissionsDisability: ~$6,000,000/ year in Capital HealthMortality: a measurable excess in reviewsInfo from Emergency Database, Decision Support, Occupational Health and Pharmacy
7 Emergency DataUnexplained Chest Pain, Headache, Panic, Abdominal Pain account for 16% of all CDHA ED Visits each year75% of all Chest Pain complaints come out with no diagnosis: 9000 visits88% of all Abdominal Pain complaints come out with no diagnosis: 7000 visits Wait Times
8 What is Intensive Short-term Dynamic Psychotherapy-ISTDP A method based on videotaped research to diagnose and address problems handling emotionsEffective with broad range of physical and psychological problemsActively researched and taught in our CentreMore information
10 Cognitive-perceptual Disruption dizziness, fainting, weakness, memory problems, accidents, injury, psychotic featuresMotor Conversion Falling, loss of speech, spasm, weakness
11 How Effective is ISTDP 21 published outcome studies Effective with multiple medical conditions and physical symptom syndromesMarked drop in Dr and Hospital costsMajority stop psychiatric medicationsAround 85% of treated patients return to work from disabilities (several studies)Single session brings 25% symptom reduction on averageSaves approximately 10 times what it costs each year through service use and disability reduction.
12 Medication Related Mixed office sample in BC Abbass, 2002
13 Health Care Utilization Abbass, Am J Psychotherapy, 2002
14 ISTDP reduced Repeat Emergency Visits for Medically Unexplained Symptoms Abbass, Campbell et al, Can J Emerg Med, 2009, 2010a, 2010bControlISTDP Innovation Grant to staff ED with Diagnostic Clinicians
15 ImplementationEstablished long term relationship between CEH and EDProvided videotape based education sessions to the emergency staffDeveloped an information pamphlet for patients.Introduced rapid access referrals to the service where emergency patients were seen in less than 2 weeks when possible.Showed videotape of the emergency-referred cases we had seen.Provided literature to emergency physician and other staff.Provided a month of on-site consultation and liaison with emergency physicians.
16 Results Abbass, Campbell et al, 2009 3.8 sessions averageSignificant Improvement on symptom measure (BSI)High Patient Satisfaction ratings (~8/10)Marked increase in referral rates by more Emergency DoctorsMajor reduction in repeat Emergency Use (65-70% reduction)“Net Cost saving” of 500 per patientFunding received for 1.2 FTE Psychologists to staff the EDNamed Canadian Leading Practice by Accreditation Canada 2010Nova Scotia expected to roll this program out to other emergency departments
17 Results (cont’d)Simply understanding that emotional factors were responsible for symptoms was enough to reduce symptoms and ED use. Only 2 returned to ED, after assessment and during course of clinic.Almost all patients were suitable referrals for service. Only 2 or 3 did not fit the service.More complex patients needed coordinated TxWhile all had multiple issues, at the core of the problem was some form of attachment trauma in early life.Nearly all were moderate resistant, highly resistant or fragile
18 Conclusions The service is widely acceptable and well used Patients benefit with reduced ED visitsService use reduction can help to reduce wait timesThis service matches meeting the patient at point of entry, andExemplifies patient-centred care at Capital Health
19 More informationCanadian Journal of Emergency Medicine article:Journal of Academy of Medical Psychology articles on Cost Effectiveness and ImplementationD%20Treatment.pdfTDP%20in%20the%20ED.pdf
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