scholarly journals MP04: rEDirect: safety and compliance of an emergency department diversion protocol for mental health and addictions patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S43
Author(s):  
V. Bismah ◽  
J. Prpic ◽  
S. Michaud ◽  
N. Sykes ◽  
J. Amyotte ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Vital Signs ◽  
Mortality Data ◽  
Transport Protocol ◽  
Patient Morbidity ◽  
Mental Health Patients ◽  
Ed Overcrowding ◽  
Pilot Implementation ◽  
Withdrawal Management

Introduction: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED <48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.

scholarly journals P019: Prehospital diversion of intoxicated patients to a detoxification facility vs the emergency department: safety and compliance of an EMS direct transport protocol

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S84
Author(s):  
V. Bismah ◽  
J. Prpic ◽  
S. Michaud ◽  
N. Sykes
Keyword(s):  
Emergency Department ◽  
Medical Records ◽  
Vital Signs ◽  
Transport Protocol ◽  
Improve Quality ◽  
Danger Zone ◽  
Patient Morbidity ◽  
Protocol Compliance ◽  
Withdrawal Management

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS bypass protocol allowing paramedics to transport intoxicated patients directly to an alternate facility [Withdrawal Management Services (WMS)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS level III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on intoxicated patients presenting to Sudbury EMS. Data was abstracted from EMS reports, hospital medical records, and discharge forms from WMS. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 681 calls for intoxication. Of the 568 taken directly to the ED, 65 met diversion criteria; these were missed protocol opportunities (11%). 113 patients were diverted. There was protocol noncompliance in 41 cases (36%), but 35 were due to incomplete recording of vital signs. There were direct protocol violations in only 6 cases (5%). There was protocol failure in 16 cases (22%), and patient morbidity in 1 case (1%). No patients died within 48 hours of diversion. Conclusion: EMS providers were fairly compliant with the protocol when transporting patients directly to the ED. There was some protocol non-compliance with patients diverted to WMS, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides high levels of safety for patients diverted to WMS. Broader implementation of the protocol could reduce the volume of intoxicated patients seen in the ED, and improve quality of care received by this population.

scholarly journals P018: Prehospital diversion of mental health patients to a mental health center vs the emergency department: safety and compliance of an EMS direct transport protocol

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S83-S84
Author(s):  
V. Bismah ◽  
J. Prpic ◽  
S. Michaud ◽  
N Sykes
Keyword(s):  
Mental Health ◽  
Medical Records ◽  
Mental Health Center ◽  
Vital Signs ◽  
Transport Protocol ◽  
Danger Zone ◽  
Patient Morbidity ◽  
Mental Health Patients ◽  
Psychiatric Issues

Introduction: Prehospital transport of patients to an alternative destination (diversion) has been proposed as part of a solution to overcrowding in emergency departments (ED). We evaluated compliance and safety of an EMS protocol allowing paramedics to transport medically stable patients with psychiatric issues directly to an alternate facility [Crisis Intervention (CI)], bypassing the ED. Patients were eligible for diversion if they were ≥18 years old, classified as CTAS III-IV, scored <4 on the Prehospital Early Warning (PHEW) score, and did not have any vital sign parameters in a danger zone (as per PHEW score criteria). Methods: A retrospective analysis was conducted on patients presenting to Sudbury EMS with behavioural or psychiatric issues. Data was abstracted from EMS reports, hospital medical records, and discharge forms from CI. Protocol compliance was measured using missed protocol opportunities (patients eligible for diversion but taken directly to the ED) and protocol noncompliance rates; protocol safety was measured using protocol failure (presentation to ED within 48 hours of appropriate diversion) and patient morbidity rates (hospital admission within 48 hours of diversion). Data was analysed qualitatively and quantitatively using proportions. Results: EMS responded to 695 calls with psychiatric complaints. Of the 650 taken directly to the ED, 18 met diversion criteria; these were missed protocol opportunities (3%). 45 patients were diverted. There was protocol noncompliance in 36 cases (80%), but 34 were due to incomplete recording of vital signs. There were direct protocol violations in only 2 cases (4%). There was protocol failure in 3 cases (33%), and patient morbidity in 8 cases (18%). No patients died within 48 hours of diversion. Conclusion: EMS providers were highly compliant with the protocol when transporting patients directly to the ED. There were high levels of protocol non-compliance in diverting patients to CI, though this is largely attributed to incomplete recording of vital signs; direct protocol violations were low. The protocol provides moderate levels of safety in diverted patients. Broader implementation of a diversion protocol could reduce the volume of mental health patients seen in the ED, and improve quality of care received by this patient population.

Emergency department contact prior to suicide in mental health patients

2010 ◽  
Vol 28 (6) ◽  
pp. 467-471 ◽  
Author(s):  
D. Da Cruz ◽  
A. Pearson ◽  
P. Saini ◽  
C. Miles ◽  
D. While ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Patients

Physician Management of Pediatric Mental Health Patients in the Emergency Department

2012 ◽  
Vol 28 (9) ◽  
pp. 835-841 ◽  
Author(s):  
Mario Cappelli ◽  
J. Elizabeth Glennie ◽  
Paula Cloutier ◽  
Allison Kennedy ◽  
Melissa Vloet ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Patients ◽  
Pediatric Mental Health

Medical Screening of Mental Health Patients in the Emergency Department: A Systematic Review

2018 ◽  
Vol 55 (6) ◽  
pp. 799-812 ◽  
Author(s):  
Krithika Chennapan ◽  
Samuel Mullinax ◽  
Eric Anderson ◽  
Mark J. Landau ◽  
Kimberly Nordstrom ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Emergency Department ◽  
Medical Screening ◽  
Mental Health Patients
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