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Bed Registries Implications for Mental Health Care. 3. The current state and where we want to go. Success/leading/ evidence-based practice. The “Flow Map” – current state 2007-8. Issue/challenge. Ad hoc vs. systemic collaboration/ coordination across organizations. - PowerPoint PPT Presentation
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Bed RegistriesImplications for Mental
Health Care
The “Flow Map” – current state 2007-8
* For example: social service agency; community mental health agency; addiction treatment organization; long-term care home; school/college/university; community service organization; other organizations** Excludes The Hospital for Sick ChildrenSource: Team analysis
How people enter EDs… Once in a TC LHIN ED**… How people leave EDs…
UHN SMH SHSC
SJHC TEGH
• Voluntary• Bribed/coerced• Involuntary
• First-time visit• Repeat visit• Multiple visits to
multiple sites
• Chose site• Did not choose site
• Connected to supports
• Unconnected
• TC LHIN resident• City of Toronto• GTA and beyond
• Leave under own volition• Without being seen by a
physician• Against medical advice
• Discharged• Without referral or
follow-up appointment
• Admitted• No bed; wait in ED until
bed available or admission no longer needed
• Admitted• Transferred to bed in same
organization• Psychiatric• Medical
• Transferred to bed at different organization
• Discharged• With follow-up appointment
within same organization• With referral to hospital
service provider • With referral to community
service provider
• Registration (worker/nurse)
• Triage (nurse)
• ED team; can include:• Nurse• Social worker• Students• Resident(s) (if on)• MD• Other staff (e.g., security)
• Psychiatric Emergency Services team (n/a for MSH; if needed, refer to CAMH); can include:• Nurse• Social worker• Psychiatric assistant• Resident(s) (if on)• MD• Other staff (e.g., security)
Issue/challenge
Success/leading/ evidence-based practice
• Ill physical health• Physically healthy
• Safety concerns (for self and/or others)
• No safety concerns
• Walks-in alone• Comes with/brought by
family, friend or neighbour
• Sent by primary care provider or community psychiatrist
• Sent by community worker/organization*
• Accompanied by community worker/ organization*
• Transferred by acute care/psychiatric hospital
• Brought by crisis team (community; MCITs)
• Brought in by police• Brought in by EMS• Sent/transferred by
criminal justice system (corrections facilities/courts)
MCITs
Short-stay/ assessment beds
Addictions specialist in the ED
Management of inpatient flows
Partnerships with selected community services
Variety of “fast forward” processes Psychogeriatric
specialist in the ED
Day/outpatient services for follow-up
MH&A EDA
Environment not typically conducive for people with mental health and addiction needs
Lengthy waits often experienced through all parts of the process
Inpatient beds not available when needed
Varying models of service delivery
Little/no consistent information collected and reviewed across the system
Large number of people involved in care
Variation in practice at the individual level
Insufficient ability to identify sub-acute addiction needs
Hard to transfer people across organizations
Few complex care community services
Little infrastructure for research
Limited capacity of/ insufficient communication about the existing available alternatives to the ED
People brought to ED with shortest wait vs. one with most appropriate services
Ad hoc vs. systemic collaboration/ coordination across organizations
Disposition often determined by resource availability, not the person’s needs
No partnerships with community providers at the system level
Transition between hospital and community services not always well managed
Insufficient capacity and flow through some community-based services
Insufficient ability to respond competently to the needs of Toronto’s diverse populations (e.g., ethnocultural groups, transitional-aged youth, etc.)
MSHCAMH
2
3. The current state and where we want to go
15* CAMH = Centre for Addiction and Mental Health; MSH = Mount Sinai Hospital; SHSC = Sunnybrook Health Sciences Centre; SJHC = St. Joseph’s Health Centre; SMH = St.
Michael’s Hospital; TEGH = Toronto East General Hospital; UHN = University Health Network
Consultation with consumers, family members and community-based service providers
Partners, purpose and projects2. Membership, purpose and structure of the MH&A ED Alliance
Purpose…Partner organizations…
SHSC
MSH
SJHC
SMH
TEGH
CAMH
UHNIndicators of
Alliance impact
Seniors MH&A project
Standardized assessment
form
Frequent user project
Inter-hospital bed access
model
MH&A ED Alliance Project Team
Projects…
Provide the right care, in the right place, at the right time in a respectful, client-centered
manner through a collaborative process of reforming existing emergency MH&A services
• Reduce ED wait times• Ensure delivery of consistently
high quality care• Improve consumer and family
satisfaction• Increase capacity to serve specific
populations
16
Data is not necessarily Information. Information is not necessarily Knowledge, Knowledge is not necessarily Wisdom…And none of the above justifies Action by itself!
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