JOHN GEORGE PAVILION PSYCHIATRIC EMERGENCY SERVICES (PES)

Transcription

1 JOHN GEORGE PAVILION PSYCHIATRIC EMERGENCY SERVICES (PES) Census Management Update Board of Supervisors Health Committee November 14, 2016 Rebecca Gebhart, Interim Director Alameda County Health Care Services Agency Karyn Tribble, Deputy Director Alameda County Behavioral Health Care Services Luis Fonseca, Chief Operating Officer Alameda Health System

2 JGP PES - System Update (10/20/16) 2 REVIEW Potential Solutions & Strategies PES Staffing Community Resources POTENTIAL SOLUTIONS Expand JGP Capacity ED TELE- PSYCHIATRY PILOT Existing Resources

3 JGP PES - System Update (10/20/16) 3 Ongoing Planning & Discussion Short-Term Action Items (6-18 Months) Long-Term Planning & Potential Action Items (12 Months +) Additional Triage Doctors at PES SB82 Grant Awards (CSU s & CRT s) Stable Psychiatrist Staffing JGP Inpatient & PES Capital Expansion St Rose Tele-psychiatry Expansion of Telepsychiatry Projects to include other Emergency Departments Use of Wellness Centers & Other Community Based Resources at Discharge Use of MHSA Innovations Funding (Community Based Responses) Mobile Evaluation Teams Post Crisis Mentoring Hope Intervention Teams Exploration of system-wide discussion of Temporary Suspension of Transfers from outside hospitals.

4 JGP PES - System Update (10/20/16) 4 Community Resources & Services Community Resources Additional Mobile Evaluation Teams (MET) in Oakland & Fremont Partnerships between BHCS and Oakland and Fremont Police Departments Post Crisis Mentoring Program Goal to reduce repeat hospitalizations/ crises through positive peer support, mentoring and increased community connections and engagement. Partnership between BHCS, JGPH & NAMI South County; Innovations > Ongoing BHCS Program. Contract being finalized. St Rose Tele-Psychiatry Pilot To date, ~10% of the total 5150 holds have been discontinued, resulting in a decrease in St Rose to PES transfers. Results are promising and support further exploration of tele-psychiatry to additional emergency departments.

5 JGP PES - System Update (10/20/16) 5 Community Resources & Services Use of Existing Resources Expansion of Hope Intervention Program (HIP) Goal to provide intensive case management, resource coordination and linkage to patients discharging from PES. Currently a Transition Age Youth (TAY) program with promising results. BHCS in discussions with provider (Bay Area Community Services (BACS) regarding expansion to include Adults & Older Adults. Expansion of JGP Capacity BHCS, HCSA, AHS exploring use of existing space and/or sites. Current focus on development or expansion of new services or existing community resources.

6 JGP PES - System Update (10/20/16) 6 SUMMARY Update PES Census & Operations Census for October = 44.8 average Total registered visits from midnight to midnight + # of patients in PES at end of NOC shift who have been in PES 24 hours or greater Length Of Stay (LOS) October = 19.9 hours Number of Patients arriving daily (registered visits) 36.0 pts/day Patients staying greater than 24 hours 8.8 pts/day

7 JGP PES - System Update (10/20/16) 7 Update JGP PES Census and LOS

8 PES Census Management Proposed Strategy At times when conditions in PES exceeds the ability of the unit to deliver high quality services, there will be a temporary hold placed on accepting transfers from patients currently receiving care at area Emergency Departments and Inpatient Units. Transfers that have already been accepted will continue through the process and be admitted to PES. Important Considerations The following factors will be among those taken into consideration regarding a temporary suspension of transfers from outside hospitals occurs: 1. Physical space in the unit (may cause the clinical threshold to be lower) 2. When current staffing levels are such that adding additional staff to ensure high quality care is problematic 3. One-to-one staffing (may cause the clinical threshold to be lower) 4. Patients waiting for an evaluation by a physician (may cause the clinical threshold to be lower) 5. Patients with a confirmed & available disposition (may cause the clinical threshold to be higher )

9 PES Census Management Plan Activation Plan Activation Once certain conditions are reached: PES activates Transfer Delay Procedure ReddiNet is activated by PES Area EDs calling for transfers are logged establishing the queue Area EDs to fax patient clinical information for pts in queue PES continuously assesses for exiting the Transfer Delay Procedure Ambulances arriving from the field will continue to be accepted Walk-ins will be accepted Law Enforcement arrivals will be accepted

10 PES Census Management Delay Implications Potential Impacts to Crisis System in Alameda County: Patients and families may seek alternative supports and use area Emergency Departments as refuges for crisis stabilization, albeit psychiatric expertise or consults may be limited. Increased walk-ins at PES; Potential for more field arrivals at PES; and Emergency Departments would be immediately impacted potentially requiring additional staffing, patient beds (designed to support individuals suffering from mental illness), and financial resources.

11 PES Census Management Essential Stakeholders Area Hospitals and Emergency Departments Law Enforcement Emergency Medical Services (EMS) Labor Representatives Families and NAMI Consumers HCSA/BHCS Board of Supervisors/Board of Trustees County Medical Societies (ACCMA) Patients Rights Advocates Mental Health Advisory Board

12 QUESTIONS? JGP PES - System Update (10/20/16) 12