*Article as appears in Hospital News

With one of the busiest mental health programs in Toronto, St. Joseph's Health Centre has worked hard to reduce wait times and improve processes so patients can access the care they need right when they need it. The Mental Health and Addictions Program has been successful in improving patient access and flow by implementing a number of strategies internally and through the continued collaboration with other service providers to help reduce system-wide barriers and bottlenecks that prevent timely access to services.

"We continually see and treat mental health patients with more complex issues, which may include placement issues from long-term care home facilities, complex psychiatric and medically complex patients," said Dan Land, Administrative Program Director, Mental Health and Addictions Program at St. Joe's. "Our Emergency Department (ER) alone sees on average 20 crisis patients per day, the most within the Toronto Central LHIN," he said.

The Program operates a number of inpatient and outpatient services that treat patients with schizophrenia, clinical depression, bipolar effective disorder and those with concurrent mental health and addictions issues. The Program is also one of the few in the city that has an addictions team that can see patients quickly in the Emergency Department.

Land's team has developed four major strategies aimed at improving patient flow within the Program:

• Decreasing the amount of time patients are waiting in the crisis area of the ER for an inpatient bed.
• Decrease the patient's Average Length of Stay on our inpatient units.
• Standardizing daily patient discharge times at 11 a.m. and 2 p.m.
• Decrease the amount of time it takes to transfer a patient from the crisis unit to inpatient floor.

The Program has also set a number of targets to track and measure their improvements. Land said their first steps included reviewing discharge and admission processes, improving communication and reducing inefficiencies to free up staff time. Gains in these areas have allowed staff to focus more on moving patients quickly, safely and effectively, enhancing the care they receive.

Some of the other methods that have been implemented in the Program include:

Red/Yellow/Green Communication Board
This visual tool uses a colour-coded system that shows when a patient will most likely be discharged - red (more than 3 days), yellow (two to three days) and green (24 hours – by 11:00 a.m. on the day of discharge). The goal is to prevent last minute discharges so staff can prepare in advance and ensure patients are discharged safely. "This tool is helpful because anyone can come to the unit to see the board and will know the status of discharges at a quick glance."

Patient Flow Maps
Staff use these maps to engage the patient and their family in a conversation about key activities that need to take place prior to the patient's discharge. The flow maps include information about arrangements for additional services and education about their medications.

Improved transfer process from ER crisis area to inpatient unit
Nurses from the inpatient units are now transferring ER crisis patients directly to the floor, which has ensured that patients get to the appropriate bed they need in a timely fashion.

Enhancing community links and partnerships
The Program works closely with community agencies and our Mental Health and Addictions Population Panel to improve access for patients into our Program and better flow of patients into a community setting for care when appropriate.

Patient/Family Engagement Rounds
This initiative involves the Patient Care Manager meeting with each patient and their family to discuss care and discharge plans. These meetings help staff to gather important information about the patient to engage them and their families in their care delivery process.

Electronic White Board
This system visually shows all of the mental health patients who are waiting for a bed and helps to prioritize their placement. It also tells staff when they need to get a bed ready for a transfer so this can be done quickly and safely. The program also uses what is called a Teletracking system.

Mental Health and Addictions ER Alliance
St. Joe's is one of six hospital partners in the Alliance, which is working collectively on a number of initiatives to improve flow of mental health patients from the ER to the most appropriate bed across the Toronto Central LHIN.

"Although we have a very busy ER for mental health clients we have been able to see some significant improvements (across the Program)," explains Land. "There are less patients waiting in the ER, shorter inpatient stays, planned discharges, improved communication and linkages in the community and a decrease in re-admission rates. These improvements would not have been possible without the effort of all of the managers, physicians and front line staff focusing on these initiatives."

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Page last updated: April 30, 2010