Improving community care for patients discharged from hospital through zone-wide implementation of a seamless care transition policy

Abstract

Background Several studies within the psychiatry literature have illustrated the importance of discharge planning and execution, as well as accessibility of outpatient follow-up post-discharge. We report the results of implementing a new seamless care transition policy to expedite post-discharge follow-up in the community Addiction and Mental Health (AMH) program in the Edmonton Zone, Alberta, Canada. The policy involved a distribution mechanism for assessment by a Mental Health Therapist (MHT) within 7 days of discharge as well as a dedicated roster of community psychiatrists to accept newly discharged patients. Methods Our study involved a retrospective clinical audit with total sampling design and a comparison of data one year prior to (2015/2016 fiscal year) and one year after (2017/2018 fiscal year) the implementation of the seamless care policy within the Edmonton zone. Extracted data was analyzed with simple descriptive statistics and presented as percentages, mean and median. Results Overall, with the enactment of this policy, follow-up volumes ultimately increased, whilst wait times for initial assessment decreased on average for patients discharged from hospital. In the 2015/2016 fiscal year, MHT completed 128 assessments of post-discharge patients who were new to AMH community compared to 298 completed new assessments for the 2017/2018 fiscal year. The corresponding wait times for the new MHT assessments were 12.7 days (median of 12 days) and 7.8 days (median of 6 days), respectively. Similarly, psychiatrists completed only 59 assessments of post-discharge patients who were new to the AMH community compared to 133 new psychiatric assessments for the 2017/2018 fiscal year. The corresponding wait times for the new psychiatric assessments were 15.3 days (median of 14 days) and 8.8 days (median of 7 days), respectively. We correspondingly found a slight decline in readmission rates after the implementation of our model in the subsequent fiscal year. Conclusion We envision that this policy will set a precedent with regards to streamlining post-discharge follow-up care for admitted inpatients, ultimately improving mental health outcomes for patients.

Harm reduction strategies in acute care for people who use alcohol and/or drugs: A scoping review

“…Thirty-two of the included articles reported delivering interventions in EDs [25, 27, 28, 30-34, 37, 40, 41, 44, 46, 47, 49, 51, 53-55, 61, 63, 66, 69, 71-76, 78, 80, 81], while twenty-two studies PLOS ONE [40,41,44,56,68,69,71,76], amphetamine use (n = 1) [78] or cannabis use (n = 1) [60]. Interventions which were not targeted to address a specific drug or targeted poly-drug use were categorized under substance use and represented 18 of the included articles [23,33,34,36,38,42,43,45,46,58,59,64,67,73,77,[79][80][81]. Interventions targeting alcohol and opioid use were predominantly set in the ED, whereas interventions targeting substance use were predominantly set in inpatient settings.…”

“…These interventions exclusively occurred in the emergency departments and addressed either alcohol use (n = 6) [40,41,44,69,76,81] or substance use (n = 4) [46,73,80,81]. The use of peer recovery supports (n = 9) [30,31,34,38,52,59,63,70,75] and specialized teams (n = 4) [24,36,77,79] were also common and targeted opioid and substance use exclusively.…”

“…(Continued) (n = 15)[23, 24, 29, 35, 36, 38, 39, 45, 50, 56-58, 68, 70, 77], critical care (n = 2)[60,65], psychiatric, mental health or pain programs (n = 3)[43,59,79], and rehabilitation programs (n = 2)[26,64].Interventions targeted several types of drug use, including opioid use (n = 31)[24-32, 35, 37, 39, 47-55, 57, 61-63, 65, 66, 70, 72, 74, 75], alcohol use (n = 8)…”

“…Table 1 presents a full overview of intervention characteristics. All of the included interventions utilized at least two of Hawk et al's harm reduction principles, with pragmatism being the most common (n = 34)[23-28, 30-33, 35, 37-39, 47-51, 53- 58, 60, 63, 66, 68, 70, 74-76, 78], followed by individualism (n = 33)[24, 25, 29-31, 33, 36, 38, 40-44, 46, 52, 57-59, 62-65, 67, 70-75, 77, 79-81], incrementalism (n = 24)[24, 28, 31, 34, 36, 38-43, 45, 53, 57-59, 61, 62, 65, 67, 71, 73, 77, 79], autonomy (n = 19)[27,29,30,35,37,43,44,46,47,50,54,59,64, 66,67,70,75,80,81], accountability without termination (n = 19)[23, 24, 26, 30, 37, 39-41, 44, 46-48, 50, 55, 63, 64, 68, 76, 80] and humanism (n = 14)[28,34,36,40,41,44,45,52,58,59,61,65,72,79] (Table2).…”