Posthospitalization Care Transfer for Clients with Depression Dr

Post-hospitalization Care Transfer for Clients with Depression Dr. Navin Kaicker, Martine Lopez, Mary Anne Oribhabor, Tina Smith Krans William Osler Health System Patients over the age of 18 with major depression are not receiving timely access to community mental health treatment following discharge from their psychiatric hospitalization on GEN B. Waiting a long time for support services in the community can cause patient depression to worsen and lead to patients seeking services in crisis. There is also a higher risk of suicide during the two weeks postpsychiatric hospitalization. 1. Increased use of OTN appointments 2. Earlier discharge planning 3. Psychiatry protected time for 7 day follow -up 4. Improved documentation of patient’s community connections 5. Improved communication between inpatient and out-patient Osler programs Diagnostics Measures 2. % of GEN B adult inpatient MDD patients who are offered a scheduled follow up appointment within 7 days of discharge 3. # of days from patient discharge from hospital to follow-up appointment. 4. % of GEN B adult inpatient MDD patients who have a care plan that specifies a timeline for follow-up 5. % of GEN B adult inpatient MDD patients whose appointment was made within the first five days of admission to hospital Results During IDEAS 1. Small changes to Brampton Civic Hospital Emergency Department revisit rates for patients with MDD: 6. 45% in FY 15/16; 8. 09% in FY 16/17; and, 5. 88% in FY 17/18 2. 65% of GEN B MDD patients were scheduled with a follow-up appointment within 7 days (based on 20 randomly selected MDD pts, 13 of whom had appointments were within 7 days or less. 3. The average number of days between discharge and scheduled follow-up for GEN B MDD patients was reduced from 17 days to 8 days. (When one outlier was removed, the average number of days between discharge and scheduled followup is 6 days. ) 4. 100% of the randomly selected GEN B MDD patient charts that were reviewed included a post-discharge appointment 5. 57% of the randomly selected GEN B MDD patient charts that were reviewed received a post-discharge appointment within five days of admission. 56. 5 52 50 40 30 26 0 17. 6 20 20 10 34 32 27 27 27 CL 12 13 12 3 5 1 Target 7 days 6 16. 9 12 0 28 22 13 12 10107. 01110 11 11 7 5 59. 6 65 6 6 5 5 5 4 4 3 3 3 1 3 2 2 1 0 /2 1. Readmission rates for MDD patients for unplanned mental health reasons. UCL 26 By February 28, 2018, 75% of patients discharged from the Gen B adult inpatient unit at the Brampton Civic Hospital (BCH), William Osler Health System, with major depression (MDD) will be offered a scheduled follow-up appointment with a health care provider within 7 days. 60 5/ Aim Statement Chart: Patient Wait Times are Shorter after a 7 -day Target is Established 7/ 017 6/ 8/ 201 21 7 /2 9/ 01 11 7 / 9/ 201 21 7 /2 9/ 01 22 7 10 /2 17 0/ 10 20 /2 17 0 10 /2 17 5/ 11 20 /1 17 0 11 /20 /2 17 4/ 11 20 /2 17 7/ 12 201 /5 7 12 /20 /1 17 8/ 20 1/ 17 5/ 1/ 201 11 8 / 1/ 201 19 8 /2 2/ 018 9/ 3/ 201 25 8 /2 3/ 01 29 8 / 4/ 201 26 8 /2 4/ 01 30 8 / 5/ 201 18 8 /2 5/ 01 28 8 /2 6/ 018 1/ 20 7/ 18 4/ 20 7/ 18 5/ 20 8/ 18 9/ 20 18 Intervention/Change Ideas # of days to follow-up for MDD patients Problem Statement Date of patient discharge from hospital Organizational Enablers and Spread The main organizational and system level enablers that have contributed to our success are management and staff support, and the recognition that we are part of a larger initiative to improve the quality of care for our patients. Several management changes have slowed our progress, however, each manager has been very supportive. We are still working on spreading our change ideas to other units. Our first spread was to include all patients on the unit where changes were initiated for MDD patients. Wider spread efforts included a presentation at the CW LHIN Regional Quality Table to showcase a practical QI project that adopted Quality Standards. Sustainability • Continued collection and monitoring of outcome and process measures helps identify which changes are being maintained. • Regular staff meetings to review these measures and discuss implementation strategies helps to identify where small changes are required, and work towards the project become part of regular practice. • Sustainability efforts have taken longer than expected due to challenges finding a meeting time that works for everyone, staff concerns about increased workload, and the time required to refine new processes. Lessons Learned • Buy-in from the unit / team at the beginning of change is essential in order to be successful • Ensure that the staff are following the processes put in place • Open communication between all team members is vital. Regular reviews are crucial for sustainability • Utilize community partners effectively for discharge follow up Next Steps/ • Continue to monitor GEN B sustainability • Adapt changes to the GEN C environment and measure progress • Spread planning to include additional inpatient programs Contact Name: Tina Smith Krans Title: Research Analyst Organization: William Osler Health System Email: Tina. smithkrans@williamoslerhs. ca Phone: 905 -494 -2120 x 57657