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Mental Health and Hospitalization

  Written by: Jenna Chou, PMP, MSc., MBA Date: April 23, 2021   Substance use and addiction are complex and there are indicators reflects long-term outcomes of public health efforts, and community and social services. It also reflects the need of different populations, which are impacted by factors such as income, education, social network, housing, and personal and or intergenerational trauma.   Hospitalization of mental health patients is a complicated issue to discuss.  First of all, the process is long for both patients and providers, creating more anxiety among both the patients and providers.  Most people get hospitalized due to “apprehension”, most of the patients do not voluntarily go to the hospital to get treatments, even if they are voluntary, most of the time the on-call psychiatrist will put the patient on a 72-hour form, then release them afterwards.  Hospitalization for mental health just doesn’t work that well for certain people, and homecare for these patients will prove to be more beneficial than if they are hospitalized.   Second of all, the patients are put on mostly “downer” drugs when hospitalized, they don’t necessarily receive the medications they need for their conditions.  Below is a depiction of patient journey of hospitalization for mental health issues:  
  Patient Journey Data Involved
1 Arrival at ER Name, Demographics, payor information, primary care physician, medical history, emergency contact, patient’s medical issues input into EPIC EMR system
2 Intake admission & Registration (Triage) HL7 ADT A04 – Patient Registration
3 QR Code Wristband QR Codes, patient name, phone, address, emergency contact
4 Examination by Nurse Symptoms of patient, medication discussion, procedure to get admitted, past medical history
5 Nurse input health information into the EMR system Symptoms of patient, medication discussion, procedure to get admitted, past medical history
6 Examination by ER Doctor Your treatment will be decided by the on-call ER doctor or may be referred to a specialist such as psychiatrists
7 Emergency medication dispensed by the nurse Medication list and dispensing histories
8 ER Doctor put patient on a 72-hour Form 1 Name of the patient, date, time, prognosis, issues that warrants Form 1
9 Consultation with ER Pharmacist Medication list and dispensing histories from outside of the hospital
10 Examination by Crises Worker Treatment will be decided by the on-call psychiatrist, patient reasons for going to ER analyzed
11 Blood Test Blood test requisition
12 Urine Test Urine test requisition
13 COVID-19 swab test COVID-19 swab test requisition
14 Consultation with psychiatrist (Admit or not as inpatient) Treatment and admission to inpatient unit is decided by the on-call psychiatrist
15 Medication dispensed by Nurse as per psychiatrist Medication list and dispensing
16 Admission to Inpatient Unit HL7 ADT A01 – Patient Admission
17 Security brings patient to the Inpatient Unit Inpatient requisition given to the security to transfer to inpatient units
18 Daily consultation with psychiatrist Consultation notes, medication changes, referrals recommendation, notes to the nursing team, review of patient behaviours monitoring
19 Pharmacy brings up patients’ medications Medication list and dispensing
20 Nurses dispense the medications at the right times and right doses Medication list and dispensing histories are input into the EMR system
21 Referrals to pain clinics Referral forms
22 Referrals to case management team Referral forms
23 Referral for CBT Programs Referral forms
24 Discharge HL7 ADT A03 – Patient Discharge
25 Patient receives medication list to fill as outpatients Medication list
26 Discharge report Discharge report and medication list while in inpatient
27 Patient goes home Appropriate transportation requisition
28 Outpatient Programs Outpatient clinics takes over the patients’ healthcare record and data
    The mental health issues struggle after hospitalization.  Most of the patients aren’t completely treated before they get released from the hospital.  The hospitals usually do not have a long-term stay psychiatric ward, allowing patients to adjust to their medications.  Most of them end up returning to the hospital due to medication changes or relapses.  Hospitalization simply doesn’t satisfy the needs of patients with mental health issues.  Home care is at the forefront in this!   CIHI (Canadian Institute for Health Information) research found that:
  • 1 in 10 Canadians who visited an ER for help with mental health and/or addictions did so at least 4 times in one year.
  • Half of these frequent ER visits were related to patients who were treated for both a mental health condition and an addiction.
  • Half of frequent ER users who visited for help with mental health and/or addictions were younger than 35.
  Homecare is a vital service for many Canadians who need assistance but do not require hospital care.  This indicator measures the number of day patients remain in hospital while waiting for homecare services or supports to be ready.  According to CIHI’S research, 1 in 12 patients do not have access to community or homecare after they are discharged from the hospital.  That is equivalent to 3 large hospitals filled each day with people who do not need hospital care.  Patients with extended stay are rare, at most for an additional 7 days only.  Most of the extended stays were females.   This article explores the current mental health journey of a regular patient.  If we have homecare ready for the patients when they are discharged from the hospital, there will be more resources available at the hospital for people who really need to be hospitalized.      

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