Faced with a significant increase in demand for mental health services, Queensway Carleton Hospital conducted a soul-searching review of its program and made big changes. The results: higher patient satisfaction, lower readmissions, and better health outcomes.
Here is how it unfolded.
Over the last five years, QCH faced a 32 percent increase in mental health visits to the Emergency Department. The inpatient unit had been full or spilling over to other units almost every day.
“Attitudes about mental health are changing our society,” said Dr. Andrew Falconer, Chief of Staff at QCH. “More people are talking about mental illness. More people are coming through our doors looking for help.”
It’s for that reason that QCH undertook a full-scale review of its mental health program – the first in the hospital’s 40-year history. They brought together an inter-professional team, including patients with lived experience.
“It has really changed the way we think about our care. We had to take a step back and ask ourselves who the community needs us to be and what we need to be doing differently,” said Falconer.
The team had two goals in view; improve access to care and improve the patient experience. From bricks and mortar to programs and outcomes, big changes have been introduced across the board.
One key change was the introduction of a Crisis Intervention Service which dedicates specially-trained nurses to respond to mental health crises in the Emergency Department. With a nurse dedicated to seeing the patient soon after the ED team assesses that they need enhanced mental health services, the process of receiving the focused mental health assessment and treatment can start quickly without having to wait long hours or having to be admitted. Patients also spend more quality time with someone focused on their care and create a plan for next steps.
“You see the patient, they are in crisis, and they’re desperate for help. In two to three hours you can see the difference,” said Payam Noshad, a crisis intervention nurse.
They took a hard look at how they could increase the number of people they helped each year in the inpatient unit – examining their communication processes, discharge processes, staffing and how they scheduled their work.
They also wanted to increase their focus on treating the person, not the illness. This involves looking at the mental, social, and physical issues. For example, they added a peer support program to connect current patients with peers who had a successful experience. This program has seen glowing reviews.
To measure the overall impact of these changes, the team needed to look at two of the most important indicators: health outcomes and patient satisfaction. Both are up.
Wait times for outpatient appointments were tackled by introducing more precise assessment methods during intake, ensuring the right patients were meeting the right clinical professionals at the right time. Dedicated weekly appointment times for the most urgent cases were also introduced to meet the most urgent patients sooner. QCH also recruited three new psychiatrists, bolstering the mental health program through and through, and helping reduce wait times.
More improvements ahead
It’s a story worth celebrating, but it isn’t over.
Design is complete for a new expansion to the Mental Health unit and the hospital hopes to begin construction 2019. This will make a huge improvement to the patient experience, as the 40-year old building is in need of a facelift and some private rooms to help better promote healing.
“We know there is more we can do, and we will keep working at improvements big and small,” said Falconer. “Hope is rising for the future of mental health care.”