About the Project
Both patients and clinicians often identify transitions between community and hospital care as challenging, whether due to delays in transferring information between care teams or problems in finding physical space for patients in high volume units. The Psychiatric Emergency Services (PES) team at Royal Jubilee Hospital identified a key transition issue for patients coming back to the hospital on an Extended Leave recall process (Form 21) under the Mental Health Act.
They noted an administrative backup could occur when some patients were transferred to hospital without sufficient information, causing increased wait times for patients. The PES team would spend valuable time seeking clarification from their community partners on what had precipitated the recall, what level of care was being recommended (reason for recall), and what the goal was for the admission. These delays negatively impacted patient care, created workload inefficiencies, and added to an already strained capacity within the emergency department. One of the PES team members, nursing unit assistant Jenna Smith, shared the broader context of the project: “Working in the emergency room, everyone is just making the best of what is happening, and filling in the gaps when you can. This project was a way to take a step back and look at what wasn’t working. Everyone knew it was the right thing to do”.
To address these challenges, the PES team sought to engage with their myriad community partners to improve communications around Form 21 patients. Bringing together staff and clinicians from PES, the Assertive Community Treatment (ACT) team, Victoria Mental Health Centre (VMHC), Victoria Integrated Community Outreach Team (VICOT), the Integrated Mobile Crisis Response Team (IMCRT), and the Emergency Department at Royal Jubilee Hospital, the group worked to develop consensus around communication processes to support these patients.
Following engagement around this, work will continue with Community MHSU team leadership to optimize the “checklist” format. This will ensure communications are flowing in a way that meets both community and acute teams, with benefit to the patient and overall care experience. Importantly, these discussions also raised awareness about what information was needed in the hospital to ensure a smooth encounter and improve patient flow, as well as other improvement opportunities that were able to be shared with Island Health’s regional Mental Health Act team. “It was important to let all the teams know what we need to improve flow and patient experience”, says Dr. Hendri-Charl Eksteen, psychiatrist in PES and project lead.
Project members shared that an unintended benefit of the project was being able to meet with the community partners, who had often only been communicated with by email or phone. This opportunity to strengthen that relationship while doing quality improvement was a key source of satisfaction for the team. “It was so great to build the rapport and familiarity between acute and community teams, and to have a better understanding of each person’s side”, said Jenna. The team also noted that other than the cost of bringing people together, this was a zero-cost intervention. “We are so grateful for the support provided to help collaboration between teams and physicians.”