SETTING UP A TELE-PSYCHIATRY SERVICE FOR ...SETTING UP A TELE-PSYCHIATRY SERVICE FOR RURAL EMERGENCY...
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SETTING UP A TELE - PSYCHIATRY SERVICE FOR RURAL EMERGENCY DEPARTMENTS DR. RAHUL GUPTA FRANZCP CLINICAL LEAD – NMHEC-RAP HUNTER NEW ENGLAND MENTAL HEALTH SERVICE 1
Transcript of SETTING UP A TELE-PSYCHIATRY SERVICE FOR ...SETTING UP A TELE-PSYCHIATRY SERVICE FOR RURAL EMERGENCY...
SETTING UP A TELE-PSYCHIATRY SERVICE FOR RURAL EMERGENCY DEPARTMENTS
DR. RAHUL GUPTA F RAN Z CP
CLINICAL LEAD – NMHEC-RAP
HUNTER NEW ENGLAND MENTAL HEALTH SERVICE
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NMHEC-RAPNORTHERN MENTAL HEALTH EMERGENCY
CARE -RURAL ACCESS PROGRAM
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PETER KEMP (SERVICE DIRECTOR)
PAM DAVIS/SOPHIE PHILLIPS (TEAM MANAGERS)
KATE SIMPSON (CLINICAL COORDINATOR)
ANNE UNICOMB (PROGRAM MANAGER-MOH)
JAY JONES (PROJECT COORDINATOR)
&NMHEC-RAP CLINICIANS
NMHEC-RAP TEAM
IntroductionProject Background ImplementationOperating ProceduresFacts & FiguresChallengesSummaryReferences
OUTLINE
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Mental Health (MH) patients often present to rural EDs
Extended wait in ED MH assessment. Stretched and under resourced Community Mental
Health Services - limited response to EDs. If no local MH service - patient need to be
transported. Limited transport options; none after-hours Vast geographical distance – ED to MH Facility e.g.
Grafton ED to Lismore is 131km or 1hr 34mins. If transported & not admitted, patients are required
to find their own way home.
PRE-NMHEC-RAP: A RURAL HOSPITAL PERSPECTIVE
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Presenter
Presentation Notes
It was common for mental health patients to wait for significant periods in the Emergency Department for an assessment prior to implementation of the Northern MHEC-RAP service. The Clarence Valley Mental Health Service, experienced ongoing resource challenges and the shear size of the geographical area serviced, made consistent response to the Emergency Department difficult. Mental Health patients experience extended waiting times to access Ambulance transport and were often delayed further due to patients with a higher clinical need taking priority. NSW Ambulance do not transport mental health patients between the hours of 8.00pm and 8.00am. The nearest Declared MH Facility is 131kms between Grafton and Lismore and 60kms between Byron and Tweed Hospitals. It was not uncommon for patients who were transported by Ambulance to the nearest DMHF to be assessed and those deemed suitable for discharge, then having to find their own way home. As you can see this paints a fairly compelling argument for change.
MH COMMISSION OF NSW - REPORT
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NSW Government funded project In response to “Living Well – A Strategic Plan” (Mental
Health Commission of NSW, 2014)
Establish new mental health resource hub staffed - mental health professionals, operating 24 x 7 support rural and remote communities of northern
NSW.NMHEC-RAP is joint initiative Hunter New England LHD, Mid North Coast LHD, Northern NSW LHD.
NMHEC-RAP
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Medical officers (in absence of AMOs) can do Schedule 1 (s19A) and Form 1(s27A) via videoconference. If can be done with “sufficient skill & care”
AMOs can undertake Form 1 assessments at a declared MH facility of which they are not an employeeAccredited Persons (APs) can do Schedule
1 (s19A) via videoconference
MH ACT 2007 CHANGES -AUG 2015
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ORANGE
WAGGA WAGGA
GOULBURN
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NEWCASTLE
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Mental Health Professionals provide
MH expertise to regional, rural and remote EDs
where access to MH services is not readily available
use video conference to link with EDs
Utilize a consultation-liaison model i.e. ED retains the clinical responsibility of the patient.
NMHEC-RAP PRINCIPLES
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Builds on existing models of mental health response to EDsNMHEC-RAP is an enhancement of emergency
mental health responses; It does not replace existing face-to-face MH
input toEDsHence, it complements face-to-face services
and extends after-hours cover
NMHEC-RAP PRINCIPLES
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LHD PartnershipsHub & Spoke modelProject manager – NSW MOHProject officers at LHDsHow this was evolvedConsultationData gatheringSite VisitsDevelopment of MOC and Operational Guidelines
PROJECT IMPLEMENTATION
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Co-located with the Mental Health LineRecruitment & training of additional staffMH Assessment training – Role playAccreditation training - Mental Health ActRoll out – 4 sites initially, then on a
schedule
PROJECT IMPLEMENTATION
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HOW DID WE SPREAD THE NEWS?
A Fact Sheet was disseminated LHD wide in late February 2016 to introduce the Northern MHEC-RAP service.
This flyer was distributed LHD wide via email just prior to Go Live.
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Identified site sent information –Operational procedures etcSite visit by NMHEC-RAP Dr & clinicianSite visit by project coordinator –
Telehealth CartGo live!Regular feedback meetings – weekly ->
monthly
PROJECT ROLL-OUT
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Located at the grounds of James Fletcher Hospital, NewcastleStaffMental Health Professionals – multi-disciplinaryMedical staff – Psychiatrist 0.6 FTE & Psych Reg
1.0 FTE
Service Director, Team Manager & Clinical CoordinatorProject Coordinator
NHMEC-RAP HUB LOCATION
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PHOTO JFH
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NHMEC-RAP ASSESSMENT ROOM
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WORKSTATION ON WHEELS “WOW”
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NMHEC-RAP Operational model
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What is a NMHEC_RAP assessment? A NMHEC-RAP assessment is a mental health assessment where you and the mental health professional are not in the same room as each other and use technology to complete the assessment.
Can a family member be with me during the assessment? NMHEC-RAP encourages family and/or carers to participate in the assessment, if this is your wish. You can choose any support person to be with you during the assessment.
How will I see the mental health professional if we are not in the same room? The NMHEC-RAP assessment is conducted using a portable videoconferencing machine with a camera, audio and a screen.
Can I ask questions during the consultation? You and your carer should feel free to ask questions at any time before, during and after the assessment.
Why use NMHEC-RAP? A NMHEC-RAP assessment means that you will not need to travel to another hospital to be assessed. You may, however, need to travel to another hospital if you need to be admitted.
What if I don’t want to be part of a NMHEC-RAP assessment? You may choose not to participate in a NMHEC-RAP assessment. Alternative arrangements will be discussed with you.
Consent for the assessment You will be asked for your verbal consent before the assessment starts.
What if I am uncomfortable during the NMHEC-RAP assessment? You can ask to stop the assessment at any time.
Who will be part of the consultation? You will see the mental health professional on the screen. There may also be a staff member with you in the room if you do not a have support person and it is felt that you require one. All staff involved in the assessment will introduce themselves at the beginning of the session.
Maintaining your privacy and confidentiality All NMHEC-RAP assessments are secure and subject to the same privacy requirements as face-to-face Health services. The assessment will not be recorded. The mental health professional will take notes during the assessment which will be entered into your medical record, as would normally happen if you saw a Health professional face to face.
How much will the consultation cost? This service is free for people presenting to emergency departments.
PATIENT INFORMATION SHEET
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EMR(S)
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HNE - CHIME ACCESSIBLE VIA CAP
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GLEN INNES
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MH ROOM
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INVERELL
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MH ROOM
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Patients access specialist assessment and care closer to home; Reduce need to transport to MH facility for
mental health assessment.EDs - reduce waiting times for mental health
assessments Comprehensive, contemporaneous,
standardised electronic clinical documentation in EMR
BENEFITS RECAP
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Some Facts & Figures
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Commenced August 2016Total sites - 16Total Assessments – 1,325FY 2017-18 - 956
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EXISTING MH ACTIVITY OF ED
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RECOMMENDATION FOR ADMISSION 26%
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22.7
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2120
25.7
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28.5
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10
15
20
25
30
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40Percentage of Inpatient Referrals/Compared to Average
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TIME OF REFERRAL
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10
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60
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80
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Times of NMHEC-RAP Requests
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All EDs have embraced NMHEC-RAP service
Staff are happy with the quality of picture and audio of the telehealth equipment.
ED Staff have provided positive feedback re standard of assessment provided by the Hub, particularly the high standard of documentation.
Feedback from patients using the service has been positive.
HOW IS NMHEC-RAP BEING RECEIVED?
Grafton Base Hospital
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Presenter
Presentation Notes
Having demonstrated a strong commitment and willingness to engage working towards implementation has been a huge benefit for Grafton. Implementation of this new service has highlighted some local process and communication issues which will continue to be worked through. Overall the service has been a success at Grafton. A number of the key contributors such as the Executive Officer, Director of Medical Services, Clinical Director Emergency, Nursing Unit Manager ED and Manager Clarence Valley MH Services work across both Grafton and Maclean Hospitals. Word of the NMHEC-RAP success has travelled to Maclean, where they eagerly await implementation in the next round.
Challenges
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CHALLENGES
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Change managementGetting used to technology!Credibility of clinical advice given by
NMHEC-RAP staff across sites/LHDsDifferent databases and eMR systems
across the LHDs. Different pathways for internal (HNE) and
external (MNC & NNSW) LHDsMedical credentialing & jurisdiction across
3 LHDs
CHALLENGES
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Workflow – Unpredictability of NMHEC-RAPs referrals Diversion from non-NMHEC-RAP EDsVariations in processes across sites. Contact with Staff specialists – various
processes for LHDs, intra-LHD. Transport & bed finding
CHALLENGES
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IN THE END IT ALL COMES TOGETHER *
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Continuing Roll-outHunter New England (Total ~26)Merriwa, Murrurundi, Scone, Singleton,
Gloucester, Cessnock, Tomaree
Mid-North Coast TBA
Northern NSWTBA
NEXT SITES
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References
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https://www.ranzcp.org/Publications/Telehealth-in-psychiatry.aspx
Saurman, E., Kirby, S. & Lyle, D. (2015). No longerflying blind: how access has changed emergencymental health care in rural and remoteemergency departments, a qualitative study. BMCHealth Services Research. Vol 15:156.
Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/258706/ACI-telehealth-guidelines.pdf
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