Toronto’s Centre for Mental Health and Addictions (CAMH) is home to Ontario’s only standalone psychiatric emergency department (ED). CAMH’s ED volume has increased yearly, growing by 52% over five years.
CAMH saw a clear need for mental health and addictions services for patients after returning to the community and used the IDEAS program to enable the success of a new post-discharge Bridging Clinic. Since then, the clinic has seen more than 1,400 clients and their ED usage has declined by 15%.
Only 8% of CAMH’s inpatients were getting a follow-up appointment within 7 days of hospital discharge. Despite having robust discharge plans, lengthy wait times for services in the community resulted in 19.2% of patients returning to the ED due to a lack of available supports following discharge.
In addition, CAMH’s ED was serving less acute patients because it was a low barrier, accessible service. CAMH turned to IDEAS to learn the skills to implement a solution.
This project focused on a major change: opening a Drop-In Bridging Clinic. There was a demonstrated and understood need for increased acute care post-discharge and the project’s goals were within the scope of existing MOHLTC program funding. Financial support was critical to initiate the project.
The Bridging Clinic was opened after two successful pilot programs. The clinic consists of several rooms just down the hall from the ED which required minimal infrastructure changes such as increased safety features. The clinic provides drop-in mental health and addictions support weekday afternoons for targeted patients referred from the CAMH ED and inpatients preparing for discharge.
Many resources were dedicated to this project. For staffing, CAMH allocated allied health staff, a nurse, a physician, an administrative staff person, project staff, as well as management and clinical leadership support. Some of these were existing resources reallocated from pilot projects. Additional support from senior leadership, reporting and analytics, a fellow, residents, students and volunteers made a huge difference.
Equipment needs included staff computers, survey clipboards, and office furniture. Planning this initiative began months before IDEAS, which helped support an effective launch during the timeframe of the IDEAS course.
View the full project summary here.
With the help of their IDEAS QI Advisor, CAMH’s IDEAS team set an aim for their project of reducing CAMH ED visits by 10%. Below is a summary of the results and further achievements are anticipated as the clinic prepares to expand its hours to evenings and weekends in Spring 2019. Spreading this initiative will require additional staffing and space resources, which is currently being explored.
Visit Quorum’s Indicators & Change Ideas page for more information on potentially avoidable emergency department visits.
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