Bed RegistriesImplications for Mental

Health Care

The “Flow Map” – current state 2007-8

* For example: social service agency; community mental health agency; addiction treatment organization; long-term care home; school/college/university; community service organization; other organizations** Excludes The Hospital for Sick ChildrenSource: Team analysis

How people enter EDs… Once in a TC LHIN ED**… How people leave EDs…

UHN SMH SHSC

SJHC TEGH

• Voluntary• Bribed/coerced• Involuntary

• First-time visit• Repeat visit• Multiple visits to

multiple sites

• Chose site• Did not choose site

• Connected to supports

• Unconnected

• TC LHIN resident• City of Toronto• GTA and beyond

• Leave under own volition• Without being seen by a

physician• Against medical advice

• Discharged• Without referral or

follow-up appointment

• Admitted• No bed; wait in ED until

bed available or admission no longer needed

• Admitted• Transferred to bed in same

organization• Psychiatric• Medical

• Transferred to bed at different organization

• Discharged• With follow-up appointment

within same organization• With referral to hospital

service provider • With referral to community

service provider

• Registration (worker/nurse)

• Triage (nurse)

• ED team; can include:• Nurse• Social worker• Students• Resident(s) (if on)• MD• Other staff (e.g., security)

• Psychiatric Emergency Services team (n/a for MSH; if needed, refer to CAMH); can include:• Nurse• Social worker• Psychiatric assistant• Resident(s) (if on)• MD• Other staff (e.g., security)

Issue/challenge

Success/leading/ evidence-based practice

• Ill physical health• Physically healthy

• Safety concerns (for self and/or others)

• No safety concerns

• Walks-in alone• Comes with/brought by

family, friend or neighbour

• Sent by primary care provider or community psychiatrist

• Sent by community worker/organization*

• Accompanied by community worker/ organization*

• Transferred by acute care/psychiatric hospital

• Brought by crisis team (community; MCITs)

• Brought in by police• Brought in by EMS• Sent/transferred by

criminal justice system (corrections facilities/courts)

MCITs

Short-stay/ assessment beds

Addictions specialist in the ED

Management of inpatient flows

Partnerships with selected community services

Variety of “fast forward” processes Psychogeriatric

specialist in the ED

Day/outpatient services for follow-up

MH&A EDA

Environment not typically conducive for people with mental health and addiction needs

Lengthy waits often experienced through all parts of the process

Inpatient beds not available when needed

Varying models of service delivery

Little/no consistent information collected and reviewed across the system

Large number of people involved in care

Variation in practice at the individual level

Insufficient ability to identify sub-acute addiction needs

Hard to transfer people across organizations

Few complex care community services

Little infrastructure for research

Limited capacity of/ insufficient communication about the existing available alternatives to the ED

People brought to ED with shortest wait vs. one with most appropriate services

Ad hoc vs. systemic collaboration/ coordination across organizations

Disposition often determined by resource availability, not the person’s needs

No partnerships with community providers at the system level

Transition between hospital and community services not always well managed

Insufficient capacity and flow through some community-based services

Insufficient ability to respond competently to the needs of Toronto’s diverse populations (e.g., ethnocultural groups, transitional-aged youth, etc.)

MSHCAMH

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3. The current state and where we want to go

15* CAMH = Centre for Addiction and Mental Health; MSH = Mount Sinai Hospital; SHSC = Sunnybrook Health Sciences Centre; SJHC = St. Joseph’s Health Centre; SMH = St.

Michael’s Hospital; TEGH = Toronto East General Hospital; UHN = University Health Network

Consultation with consumers, family members and community-based service providers

Partners, purpose and projects2. Membership, purpose and structure of the MH&A ED Alliance

Purpose…Partner organizations…

SHSC

MSH

SJHC

SMH

TEGH

CAMH

UHNIndicators of

Alliance impact

Seniors MH&A project

Standardized assessment

form

Frequent user project

Inter-hospital bed access

model

MH&A ED Alliance Project Team

Projects…

Provide the right care, in the right place, at the right time in a respectful, client-centered

manner through a collaborative process of reforming existing emergency MH&A services

• Reduce ED wait times• Ensure delivery of consistently

high quality care• Improve consumer and family

satisfaction• Increase capacity to serve specific

populations

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Data is not necessarily Information. Information is not necessarily Knowledge, Knowledge is not necessarily Wisdom…And none of the above justifies Action by itself!