Emergency Dept. Process Improvement for Behavioral Health Patients Strategies for Improving Care for Behavioral Health Patients That Present to an ED Presenter Larry Phillips, DCSW Program Manager 1

TOPICS FOR TODAY System improvement for behavioral health patients in the ED Example of improvement: St. Anthony Hospital Questions

Emergency Department Part of SSM Health, St. Anthony was the first hospital established in Oklahoma and is largest with 774 licensed beds. Serves as a regional referral facility with specialties in cardiology, oncology, surgery and behavioral medicine. The Behavioral Medicine Center is licensed for 251 beds, includes acute inpatient programs for geriatrics and adults, as well as acute and residential inpatient care for adolescents and children. 56,312 Main ER visits in 2015 81,074 in our Freestanding ERs (4) 9,274 Behavioral Health ER visits in 2015 11,034 Total Behavioral Health visits 18% to 20% of the admissions are behavioral health 3

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Patient completes yellow form indicating they are MENTAL HEALTH PT PRESENTS IN THE ED ↓ Patient completes yellow form indicating they are Homicidal, suicidal or psychotic Orange armband placed on patient, and Mental Health Tech notified to go on standby Security accompanies patient to appropriate holding area (i.e.: secure holding, ED patient room) SPOE and Triage Nurse notified Triage and MH assessment initiated ED Provider assess patient – performs MSE ← Registration is notified to register patient → DOES NOT need medical or psychiatric treatment DOES need medical or psychiatric treatment SPOE provides appropriate resources Patient discharged home with appropriate resources Placed in a medical or mental health bed once cleared by ED and bed located. Tech on standby until placement /transfer is completed

Benefits to a Mental Health Tech in an ER Safety of patients AWOL reduction Decrease in staff injuries Patient satisfaction Staff satisfaction Treatment can start prior to being placed inpatient Patient advocate 7

Preparing for Change Hospitals vary in organizational culture, and the type of culture relates to the safety climate within the hospital. These results suggest a healthcare organization's culture is a critical factor in development of its patient safety climate and in the successful implementation of quality improvement initiatives. British Med Journal Organizational Culture: Variation Across Hospitals and Connection to Patient Safety Climate http://qualitysafety.bmj.com/content/19/6/592.abstract Guide http://www.ahrq.gov/qual/patientsafetyculture/usergd.htm

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Guidelines for Cultural Change Formulate a clear strategic vision Display top-management commitment Model culture change at the highest level Modify the organization to support organizational change: identify current systems, policies, procedures and rules to be changed to align with the new values & desired culture. Select and socialize new employees and terminate those unwilling to change. Develop ethical and legal sensitivity Include a periodic evaluation process to monitor the change progress and identify areas that need further development.

Key Questions What are we trying to accomplish? How will we know we have made an improvement? What changes can we make that we predict will result in improvement?

Getting a Better Result: The Basic Rules Establish a goal Identify a process Involve others Try changes Measure results Repeat

“CULTURE EATS PROCESS FOR LUNCH”

“Every System is perfectly designed to achieve the result it gets “Every System is perfectly designed to achieve the result it gets.” “If you want a different result, you have to change the system.” Donald Berwick, MD and others