Granite Falls Municipal Hospital. Mental Health Transport Project

Transcription

1 Granite Falls Municipal Hospital Mental Health Transport Project

2 Granite Falls Municipal Hospital is a Critical Access Hospital 25 bed hospital 24/7 Emergency services Service area of a 30 mile radius Population serviced of 8, acute admissions in 2014 Average daily census of 7 Payers for patients 58% Medicare 10% Medicare Advantage 4% Medicaid 5% Self pay 23% Other insurance

3 Focus of Emergency Care at GFMH&M GFMH is a CALS Hospital The CALS Hospital designation represents an institutional commitment to quality rural emergency medical care. This includes: CALS training for hospital staff and providers with a team work focus Provision of medical equipment required for effective emergency care Leadership in providing excellent emergency care.

4 Emergency Room Statistics 2374 ER visits in 2014 Average of 198 visits per month Average of 6.5 ER visits per day 754 Ambulance runs in transfers to a higher level of care from ER in % ALS transport 22% Air transport 12% BLS transport 22% Car / PD / Special Transport Service

5 ALS Emergency Service Granite Falls Hospital owns and operates 4 full-time ambulances Also manages a Special Transport Service for nonemergent transfers Our service also does transports for Madison, Dawson and the VA in Montevideo Other ALS EMS providers: North Air and Lifelink Other BLS - EMS providers: Clarkfield, Clara City, Renville, and Cottonwood

6 Mental Health Statistics January December 2014

7 Mental Health Transport Project Pilot Desire to make MH crisis less traumatic Current system for MH transfers by ambulance or police problem-prone Collaboration with: Granite Falls Municipal Hospital & Ambulance Service YMC Family Services YMC Law Enforcement

8 Pilot Project DHS Adult Mental Health Initiative Crisis Services Funding Grant $7300 Patient Support Services Transportation Services

9 Yellow Medicine County YMC Family Services Provided car YMC Sheriff s office cage, radio

10 Reimbursed Expenses Auto Insurance Gas Maintenance Repairs Hourly reimbursement for transportation time Hourly reimbursement for staff time providing patient over-sight Staff Training

11 MD Certification for level of transport Peace Officer vs Ambulance Consent Transport Car Trained Ambulance Staff (de-escalation, signs/symptoms to watch for, personal safety training)

12 Lessons Learned 72 hour hold MD discretion for psych car vs. PD vs. ambulance Staff education arriving at the accepting facility and assuring a staff member escorts the patient into facility. Requesting PD assistance if necessary. Staff training on how to handle MH patients safely and efficiently.

13 Case Example Car vs Ambulance Impact of safety for staff and the patient Ambulance transport would possibly have result in a sedated and intubated patient; the patient would have ended up in an ER and/or ICU capable of handling an intubated patient with delay in mental health care & treatment

14 Consent form

15 Psych Transfer Form

16 DHS Mental Health form

17 Western Mental Health Mobile Crisis Team Available 24 hours a day, 7 days a week to provide support to adults, children, and families who are experiencing a mental health crisis in the comfort of their own home or other community location.

18 Services include: Telephone crisis intervention On-site response to assess and stabilize a crisis situation Short-term stabilization services through brief on-going support Individual and family education Referrals to other local services Crisis prevention planning

19 Paul Nistler Executive Director Upper Mississippi Mental Health Center

20 HISTORY- I was informed by our County Sheriff that the Sheriff s Office was no longer able to provide mental health transports due to staffing/financial issues. This included all transports from hospital to hospital. We worked out a temporary solution but after several months it was not sustainable.

21 We had many meetings over many months. We learned that in desperation Doctors and nurses were paying family members to drive loved ones to MH hospitals when needed. UMMHC mobile crisis MH response team was already in place and was also trying to arrange transportation when we could. It was a daunting task. In spring of 2010 I went to my board of directors and the MH Region 2 Initiative (which includes the Counties of Beltrami, Lake of the Woods, Clearwater and Hubbard Counties) and stated that UMMHC would take this task on. There was no other program like this in the State to follow so I started from scratch.

22 Several things needed to happen to make this Transportation Program work. In order to do a quality job we needed partnerships. These partnerships all had important roles to play. Triage System was developed the who, what, where, why and how. Policy and Procedures Developed. Policy needed to be written for Agency use and other Agency use. Beltrami County became a major player. Support from the County Board, Law Enforcement and Dispatch was necessary and extremely important.

23 Once policies and procedures were in place and the boards provided approval we were able to begin. That was November We started out with 2 retired squad cars both donated to the program. We developed a communication program with the Beltrami County 911 Dispatch Center. Their Communications Officers are an integral piece to this program. They provide service 24/7, 365 days a year. The drivers are civilian employees of the MH center. We are in constant daily communication.

24 MH First Aid CPR/First aid training (one heart attack so far) Defensive driving training De-escalation training Participation in quarterly crisis meetings Radio emergency communications Pager Communications

25 We have come along way from that first year we currently have three vehicle we use for MH transporting: Dodge Charger, Dodge Durango and a Dodge Town and Country Mini van Each vehicle has the following equipment: GPS real time locator (Verizon) Digital Camera all transports are video taped and stored. Radiocommunication with LE if needed. Cell Phone booster, first aid kits, defibrillator, fire extinguisher. Vehicles are not marked but a protective barrier in installed between the driver and back seat passenger.

26 The Beltrami County Dispatchers act as the eyes and ears of the program (including providing a 24/7 number for Emergency Departments to call to start the process for transport which opens a case that is monitored and updated in the Dispatch Center from start to finish) and, once the driver is paged, Dispatch tracks the vehicle and driver including start and end times, pre-approved routes that include main roads with law enforcement assistance available at any time, arranging pit stops at law enforcement agencies along the way, and sending emergency help whenever needed. Dispatch serves as the communication hub for the entire route traveled as well as returned. The Dispatch Supervisor also investigates all questionable requests to deny or allow.

27 We started transporting children in July of 2012 but due to the child restraint and child seat law, all juveniles must be 4 9 tall or we are not legally allowed to transport. We DO NOT use car seats. Parents, guardians or loved ones are not allowed to ride with however they can follow the transport car providing they do not become a nuisance. This is a pilot program and we have been privileged to be the recipient of awards from state and private agencies. County Achievement Award by the AMC and Hubert Humphrey Innovation Award. Primewest Insurance has been a wonderful Partner with program. We have a contract with them and also with UCare. This has been a wonderful partnership with our region. We are able to provide a service that is needed. The patients appreciate the dignity and caring that happens. We received a one time gift for a new vehicle 2015 Dodge Van.

28 2013 Total Miles Driven 59,614 Mobile Crisis Team call outs 297 people Transports 285 total 2014 Total Miles Driven 71,429 Mobile Crisis Team call outs 389 people Transports 378 total

29 Vehicle Maintenance and Repairs. Insurance payments the program has not been funded by any type of payment that is available. Legislation did pass protective transportation we may now get some funding for what we do. We drive many miles to facilities as there is rarely anything available locally. Keeping up with Facility changes and rules making sure they are following through.

30 Commitment from your Hospital Emergency Departments, 911 Dispatch Centers, Sheriffs, Law Enforcement along the routes to facilities and the Facilities. After action reviews are vital. What works and what does not work changes along the way. Any miscommunications, failures of any cog in the wheel, reminders on the mission and qualifications for transport and other issues must be addressed immediately. BUILD STRONG PARTNERSHIPS

31 Success stories should be celebrated on a regular basis. Feedback is essential for all partners. The goal is to provide quality, timely, nonjudgmental transport for our citizens who are struggling with mental illness. We must never forget why our partnership is important. Every step we take in tandem with those dealing with illness is a building block in their lives.

32 THANK YOU for your interest. Questions regarding the Mental Health Transport program can be directed to: Paul Nistler, Director: Upper Mississippi Mental Health Center (218) or OR Beryl Wernberg, 911 Supervisor, Emergency Communications Director: Beltrami County Sheriff s Office (218) or beryl. wernberg@co.beltrami.mn.us