Wait times in an Australian emergency department: A comparison of mental health and non‐mental health patients in a regional emergency department

Introduction: The Canadian Institute for Health Information reports the rate of child and youth emergency department (ED) visits for mental health complaints increased by 50% between 2007 and 2015. Improving care for these patients is a major priority of Alberta Health Services (AHS). As part of a multi-phased approach to improving care, the Emergency and the Addiction and Mental Health Strategic Clinical Networks (SCNs) surveyed youth who had presented to an ED for mental health or substance use concerns and their families/caregivers. Methods: The online survey contained closed- and open-ended questions on reasons for ED visits, expectations about and experiences during their visits, and areas for improvement. An ethics approved survey was conducted for 4 weeks. Participants were recruited across the province using an extensive array of social media platforms. For each survey, we randomly selected a sample of open-ended responses to thematically analyze to the point of informational redundancy. Results: The Youth survey received 992 responses and the Family survey received 553. A small number of overarching themes emerged. For both surveys, the major themes were 1) Wait times and access: participants were disappointed with lengthy wait times and services in the community. Youth said this made them question their decision to seek help and left them feeling hopeless. 2) Care provider training: participants were unhappy with the quality of care provided (e.g., lack of compassion, minimizing symptoms). They felt better training would improve care and attitudes towards mental health patients. 3) Environment: participants were uncomfortable with the lack of privacy for discussing sensitive topics; youth also requested items such as pens/paper and phone chargers to make the stay more comfortable and provide distractions. An additional theme emerged in the Youth survey regarding family involvement; participants wanted to decide how much/what information is shared with their families. Youth noted they were less likely to be honest with family present. Communication and navigation were mentioned frequently in the Family survey; participants noted the complexity of the mental health care system and felt frustrated by the lack of information to help them access additional resources. Conclusion: There are a number of areas in need of improvement to provide high-quality, patient-centred care to youth with mental health or substance use concerns that present to the Emergency Department. Phase II of this project will involve a review of the themes and determine priorities and strategies to address the themes that could be implemented into the workflow.

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

CJEM ◽

10.1017/cem.2019.139 ◽

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.

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