AProf Alexandra Cockram

1
Transforming Access to an Acute Mental Health
Service

• A/Prof Alexandra Cockram
• NorthWestern Mental Health
• Melbourne, Australia.

A/Prof Alexandra Cockram Director NorthWestern
Mental Health Service Melbourne Australia
2
Outline of Presentation

• Overview of Southern Health
• Work Strands and Improvements
• Key Success Factors
• Lessons Learnt
• Next Steps

3
Southern Health Mental Health Program

• 750,000 catchment population in outer
  metropolitan Melbourne
• 3 acute hospital sites (3 Emergency Departments)
• 100 acute beds (4 inpatient wards)
• 580 staff
• Significant distance between sites
• Growing and diverse population

4
Significant Problems in Early 2005

• Poor access to acute inpatient services resulting
  in long length of stay in ED for mental health
  patients
• Increasing caseload for acute community based
  treatment teams
• Increasing precipitous and unplanned discharges
  for acute wards
• Poor communication between the teams
• Low morale
• High nursing vacancy rates
• High rates of sick leave

5
Strategy for Change

• Executive Director leadership
• Organisational change that crosses organisational
  boundaries
• Complex continuous pathway broken down to
  individual segments

6
Strategy for Change

• Multidisciplinary steering group including
  consumers from across the organisation
• Work groups
• Front line improvements
• Communication strategy

7
Mental Health Improvement

• 3 improvement work strands focused on
• Bed Management
• Beds are now managed within one system across all
  sites
• Inpatient Care Management
• A process has been implemented that joins the
  process from entry to community
• Emergency Care Management
• Agreement has been made to provide a service
  within agreed timescale

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Key Activities to improve inpatient capacity

• Joint management of acute capacity and demand
• Joint management by those who seek the beds and
  those who manage the beds
• Bed call 10.30 every day,
• 8 way teleconference call
• Agreed Escalation Plan
• Intranet based, up to date electronic bed tool

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Web Based - Bed Management Tool
Southern Health Bed Management Tool
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Improvements in Discharge

• The right information
• Agreement with all players
• One before 10, one before 3
• Weekly preplanning meeting
• Golden rules for discharge

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Improvements in ED Flow

• Agreements with ED physicians and nursing staff
• Review and improve access to mental health staff
  in all EDs
• MH triage tool parallels, and is incorporated
  into the acute health triage tool
• Agreed ED Escalation plans include afterhours
  responses from on call MHP clinical and
  management staff

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Mental Health Improvement
Visible action cards with expectations
Bed demand - green
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All Wards Daily Movements11/09 17/09
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Mental Health Improvement
Emergency Department length of stay gt 24 hours
for all patients with psychiatric disturbance

• July - December 05
• 71 patients waited gt24 hours
• Average waiting time was 40.2 hours
• 2857 hours spent waiting
• July - December 06
• No patients waited gt24 hours
• Average waiting time for all admitted patients is
  below 8 hours

15
Average Length of Stay in EDfor all MHP consumers
7.05
6.38
5.51
4.18
Sustained at LESS THAN 3.89 hours since January
2006
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Target 4 Hours for Discharged Patients from ED
All Sites
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Key Success Factors

• Consistent, insistent and persistent Leadership
• Need to generate obvious improvements to quickly
  build momentum
• Operational/clinical accountability with project
  support
• Reinforce clinical rationale to generate energy
  and commitment to change
• Consumer and carer participation to promote
  change and ensure change leads to improvements

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Lessons Learnt

• Early, consistent and persistent engagement of
  doctors
• Devise a communication strategy and then double
  it!
• Ensure recognition of success
• Consider individual team and how to maintain
  energy for change

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Next Steps

• New program commencing (Catchment 1.2 million
  population and 1600 staff)
• Including substantive change in community
  program from beginning
• Develop pathway with Non Government providers
  such as Psychiatric Disability Support and
  accommodation services
• Shared Care GPs, allied health, private
  psychiatrists
• Support statewide improvements

20
Contact Details

• Location of the program presented was at Southern
  Health.
• Lee Martin, Lisa Lynch, Mental Health Program
  Access Improvement Steering Committee.
• New program at Melbourne Health
• Current contact details
• Alex.Cockram_at_mh.org.au
• Director NorthWestern Mental Health
• Melbourne Health
• Royal Melbourne Hospital
• Parkville 3050