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.

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 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 Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness

2016 ◽  
Vol 25 (5) ◽  
pp. 417-421 ◽  
Author(s):  
A. Bramesfeld ◽  
C. Stegbauer
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Performance Monitoring ◽  
Guideline Development ◽  
World Health ◽  
Monitoring Programs ◽  
Mental Health Patients ◽  
Health Service Responsiveness

The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users’ legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services’ performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

scholarly journals Factors associated with low quality of life in schizophrenia

2005 ◽  
Vol 21 (5) ◽  
pp. 1338-1340 ◽  
Author(s):  
Clareci Silva Cardoso ◽  
Waleska Teixeira Caiaffa ◽  
Marina Bandeira ◽  
Arminda Lucia Siqueira ◽  
Mery Natali Silva Abreu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Low Income ◽  
Mental Health Center ◽  
Psychiatric Patients ◽  
Patient Treatment ◽  
Cross Sectional ◽  
Daily Lives ◽  
Cross Sectional Design

Interest in quality of life in mental health care has been stimulated by the deinstitutionalization of psychiatric patients as well as a parallel interest in understanding the scope of their daily lives. This study aims to investigate the socio-demographic and clinical variables related to low quality of life, using a cross-sectional design to evaluate quality of life by means of the QLS-BR scale. We interviewed a sample of 123 outpatients from a reference mental health center in Divinópolis, Minas Gerais State, Brazil, clinically diagnosed with schizophrenia. Univariate and multivariate logistic regression analyses were carried out. The results showed that low quality of life is associated with one or more of the following: male gender, single marital status, low income plus low schooling, use of three or more prescribed psychoactive drugs, psychomotor agitation during the interview, and current follow-up care. The study identifies plausible indicators for the attention and care needed to improve psychiatric patient treatment.

EFFECTS OF PERSONAL AND PSYCHOLOGICAL FEATURES OF PATIENTS WITH PARANOID SCHIZOPHRENIA ON QUALITY OF LIFE

Vestnik ◽  
2021 ◽  
pp. 127-132
Author(s):  
Г.У. Саятова ◽  
Н.И. Распопова
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Psychological Factors ◽  
Inpatient Treatment ◽  
Mental Health Center ◽  
Paranoid Schizophrenia ◽  
Clinical Analysis ◽  
Rehabilitation Potential ◽  
Psychological Features

В статье представлены результаты клинического анализа 115 пациентов, находившихся на стационарном лечении в РГКП на ПХВ «Республиканский научно-практический центр психического здоровья» и ГКП на ПХВ «Центр психического здоровья» УЗ г. Алматы с диагнозом: «Параноидная шизофрения F20.0». В процессе исследования были выявлены личностно-психологические факторы, оказывающие влияние на качество жизни больных параноидной шизофренией, определены «мишени» психотерапевтического воздействия для повышения реабилитационного потенциала этих больных. Исследована структура внутренней картины болезни у пациентов с параноидной шизофренией. Обоснованы рекомендации по формированию у пациентов с параноидной шизофренией «гармоничного» типа внутренней картины болезни для повышения качества реабилитационных мероприятий. The article presents the results of a clinical analysis of 115 patients who were inpatient treatment at the Republican Scientific and Practical Center for Mental Health and the Mental Health Center of the Almaty Healthcare Institution with a diagnosis of Paranoid schizophrenia F20.0. In the course of the study, personal and psychological factors were identified that affect the quality of life of patients with paranoid schizophrenia, and the "targets" of psychotherapeutic influence were identified to increase the rehabilitation potential of these patients. The structure of the internal picture of the disease in patients with paranoid schizophrenia was investigated. Recommendations for the formation of a "harmonious" type of internal picture of the disease in patients with paranoid schizophrenia in order to improve the quality of rehabilitation measures have been substantiated.

scholarly journals Myrllen's Coat

2009 ◽  
Vol 10 (2) ◽  
pp. 38-60
Author(s):  
Catherine Heard
Keyword(s):  
Mental Health ◽  
Health Center ◽  
State Hospital ◽  
Medical Records ◽  
Mental Health Center ◽  
Hospital Staff ◽  
Eastern State ◽  
Sewing Needle ◽  
Schizophrenic Woman ◽  
State Museum

In 1948, a schizophrenic woman admitted to the Eastern State Hospital in Knoxville, Tennessee, began shredding rags into coloured thread and begging hospital staff to give her a sewing needle. In the space of seven years, she created several garments, densely embroidered with images and glossolalic text. Ward notes dismissively summarized, “She sews without purpose…is non-productive”. In 1955 she was medicated with the newly developed drug, chlorpromazine, and stopped sewing. Over the years, most of the works were lost –– along with the medical records of their creator, who is known by the pseudonym, “Myrllen”. Today, only two artifacts remain: a scarf, which hangs in Lakeshore Mental Health Center in Knoxville; and a coat, preserved in the Tennessee State Museum. My research is the first academic study of these artifacts, which are virtually unknown outside of Tennessee and Maryland.

FACTORS DETERMINING THE QUALITY OF LIFE IN PATIENTS WITH PARANOID SCHIZOPHRENIA

Vestnik ◽  
2021 ◽  
pp. 133-137
Author(s):  
Г.У. Саятова ◽  
Н.И. Распопова
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mental Health Center ◽  
Paranoid Schizophrenia ◽  
Clinical Factors ◽  
Rehabilitation Potential ◽  
Self Service ◽  
Leisure And Recreation ◽  
Significant Factors

В статье представлены результаты анализа качества жизни 115 больных параноидной шизофренией, находившихся на стационарном лечении в РГКП на ПХВ «Республиканский научно-практический центр психического здоровья» и ГКП на ПХВ «Центр психического здоровья» УЗ г. Алматы. В процессе исследования установлено, что низкий уровень качества жизни у больных параноидной шизофренией непосредственно связан как с клиническими факторами, так и с рядом социальных личностно значимых факторов: ограниченные возможности самообслуживания, общения с другими людьми, отсутствие организованного досуга и отдыха. Это позволяет определить «мишени» целенаправленных мероприятий, повышающих их реабилитационный потенциал. The article presents the results of the analysis of the quality of life of 115 patients with paranoid schizophrenia who were inpatient treatment at the Republican Scientific and Practical Center for Mental Health and the Mental Health Center of the Healthcare Institution of Almaty. In the course of the study, it was established that the low level of quality of life in patients with paranoid schizophrenia is directly related to both clinical factors, and with a number of social personally significant factors: limited opportunities for self-service, communication with other people, lack of organized leisure and recreation. This makes it possible to determine the "targets" of targeted measures that increase their rehabilitation potential.

Service users' perceptions of quality of life measurement in psychiatry

2011 ◽  
Vol 17 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Jan Wallcraft
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
User Involvement ◽  
Service Users ◽  
Life Measurement ◽  
Outcome Monitoring ◽  
Mental Health Patients ◽  
Clinical Measures ◽  
Effective Service

SummaryThis article describes the concept of quality of life (QoL) as applied to mental health. It also outlines relevant tools for measuring QoL, both generic and health-specific, and explains their approaches and purposes. These tools are intended to enable researchers to ask questions that are more patient-centred and psychosocial than traditional clinical measures for evaluating outcomes of treatment. However, a number of studies have criticised existing QoL tools in terms of their sensitivity to change and their relevance to mental health patients' concerns. Studies have shown that patients can give accurate self-reports even when ill. Given that government and professional policies favour effective service user involvement and routine outcome monitoring, more effort should be made to develop measures in partnership with service users, as this might better reflect individual priorities in assessment of quality of life.

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