Franklin County Psychiatric Crisis and Emergency System (PCES) Task Force
Why create the PCES task force? Escalating community need Increase in med/surge referrals Overcrowding in ERs Medicaid expansion Other payment reform
Volume by Month: FCBB Reports
3
Task force representation ADAMH Franklin County
Nationwide Children’s Hospital
Central Ohio Hospital Council
Ohio Department of Mental Health
Central Ohio Trauma System
Twin Valley Behavioral Health
The Columbus Foundation
Ohio Hospital for Psychiatry
Columbus Springs
Ohio Health
Maryhaven
OSU Wexner Medical Center
Mount Carmel West
Osteopathic Heritage Foundation
National Alliance of Mental Illness
Primary One Health
Netcare Access
Goals
Increase access to patient-centered mental health and addiction-related crisis services and expand intermediate and ambulatory care options
Decrease utilization of emergency departments and inpatient services and reduce the length of stay of psychiatric patients in emergency rooms
Ensure equitable patient care regardless of payor source PCES
Recommendations
1 PCES
Create a comprehensive, collaborative system of crisis care for individuals experiencing mental health and/or addiction emergencies.
Recommendations
2
Identify and develop additional options for intermediate and ambulatory care for individuals in need of mental health and/or alcohol and drug addiction treatment. • Expand role of community mental health centers (pilot program) • Increase the use of crisis action teams, mobile crisis teams, and telepsychiatry.
PCES
Recommendations
3
Build collaborative, effective working relationships with the payor community to favorably encourage an improved model which ensures that patients receive access to high quality care in a cost-efficient manner. • Foster positive, productive relationships with payors • Work to eliminate barriers to treatment for patients in freestanding facilities
PCES
Recommendations
2
Pilot: Linkages between Grant Medical Center ED and Southeast Inc. Southeast
clinician is housed at the Grant ED between 10 a.m. and 2 p.m. on Saturdays and Sundays.
Clinician
can access the patient’s clinical information and has the ability to do real-time scheduling.
Results: 33% decrease in the average time to disposition for patients seen by Southeast clinicians. PCES
Recommendations
3
Pilot: Telepsychiatry consult in EDs where psychiatric services are not available
OhioHealth: Average length of stay for psychiatric patients in Doctors ED reduced by 26%.
ALOS for psychiatric patients in the ED who were admitted to an inpatient psychiatric unit was reduced by 28%.
Number of patients admitted to an inpatient unit decreased 10%. Patients discharged home instead of admitted to an inpatient unit
PCES
Feasibility of Centralized and Collaborative System of Care ď ľ The
goal is to provide a report to inform the PCES Task Force of models of care that can ensure the right level of care as quickly as possible for behavioral health patients
PCES
Mixed Methods Approach to Develop Models of Care Delivery Literature Key
Review
Informant Interviews
Focus Data
Group and Expert Panel
Analysis from Franklin County Hospitals
PCES
Model 1: Franklin County Behavioral Health Emergency Facility Model Overview Bricks and mortar behavioral health emergency facility
Linked EHR
EMS triage on-site before transfer to facility
Law Enforcement/Social Worker response team
Case managers/social workers to improve community linkages
Medicaid reimbursement code activation PCES
Highlights Emergency facility specifically for behavioral health patients with varying levels of care
EHR interoperability to more rapidly share information
Specialized response units to deescalate and better assess behavioral health needs
Increase connectivity to community resources and improve follow-up rates
Logic Model 1: Behavioral Health Emergency Facility Inputs Structural: Facility Transport Office space for community resources Funding
PCES Personnel: Behavioral Healthcare personnel
Logic Model 1: Behavioral Health Emergency Facility Activities
Structural: Construction of facility Create transport protocol for patient transport/transfers Carry out fundraising efforts
Personnel: PCES
Hiring BH providers
Logic Model 1: Behavioral Health Emergency Facility Outputs
Structural: BH Emergency Facility # of offices for community resources $ raised for facility Finalized protocol for transport/transfers
PCES
Personnel: # of BH providers hired
Logic Model 1: Behavioral Health Emergency Facility Outcomes Health: Decrease ED visits for BH Decrease BH inpatient admissions Decrease minutes waiting in ED Decrease days BH inpatient stay Decrease hours of ED on divert Decrease hours of physical restraint
Community: IncreasePCES discharges to community Decrease BH-related incarcerations
Model 2: Behavioral Health Electronic Hub Model Overview EHR Interoperability and information sharing is critical
Current facilities remain with inter-connectivity to alert providers to patients in need of services EMS and Law Enforcement Training still needed Increased availability for outpatient resources needed
PCES
Highlights Care coordination staff will be responsible for monitoring electronic system
Care coordination notifies appropriate site/provider for availability of services for patient
EMS and Law Enforcement to deescalate and manage on-site, can notify care coordination is services needed
Logic Model 2: Behavioral Health Electronic Hub Inputs Structural: Transport Office space for Care Coordinators Funding
Personnel: PCES
Behavioral Healthcare personnel
Logic Model 2: Behavioral Health Electronic Hub Activities Structural: Dedicated office space for care coordination Create transport protocol for patient transport/transfers Identify funding sources
Personnel: PCES Hiring BH providers
Logic Model 2: Behavioral Health Electronic Hub Outputs Structural: # of offices for care coordination Finalized protocol for transport/transfers $ allocated for system
PCES Personnel: # of BH providers hired
Logic Model 2: Behavioral Health Electronic Hub Outcomes Health: Decrease ED visits for BH Decrease BH inpatient admissions Decrease minutes waiting in ED Decrease days BH inpatient stay Decrease hours of ED on divert Decrease hours of physical restraint
Community: IncreasePCES discharges to community Decrease BH-related incarcerations
Group Breakouts
Review the proposed logic models for the model assigned to group
Keep in mind that these are simplified, highlevel representations of the model
Consider additional components needed for consideration or components to be removed
Fill in blank logic model sections with additional components
PCES
Questions
PCES