SETTING U G UP A TELE-PSYCHIATRY S Y SERVICE CE F FOR R RU - - PowerPoint PPT Presentation

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SETTING U G UP A TELE-PSYCHIATRY S Y SERVICE CE F FOR R RU RURAL E EMERGENCY D NCY DEPART RTMENT NTS DR. R RAH AHUL G GUPTA FRANZCP CLINICAL LEAD NMHEC-RAP HUNTER NEW ENGLAND MENTAL HEALTH SERVICE 1 NMHE MHEC-RAP RAP NORT

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SETTING U G UP A TELE-PSYCHIATRY S Y SERVICE CE F FOR R RU RURAL E EMERGENCY D NCY DEPART RTMENT NTS

  • DR. R

RAH AHUL G GUPTA FRANZCP

CLINICAL LEAD – NMHEC-RAP HUNTER NEW ENGLAND MENTAL HEALTH SERVICE

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NMHE MHEC-RAP RAP

NORT RTHERN ME MENTAL H HEALTH E EMERGENCY CA CARE - RURAL A L ACCESS P SS PROGR GRAM

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PETER K KEMP MP (SERVICE DIRECTOR) PAM D DAVIS/ S/SO SOPH PHIE P PHILLI LLIPS PS (TEAM MANAGERS) KATE S SIMPSO PSON (CLINICAL COORDINATOR) ANN NNE UNICOMB (PROGRAM MANAGER-MOH) JAY JO Y JONES (PROJECT COORDINATOR) & NMHEC-RAP C P CLINICIANS

NMHEC EC-RAP T AP TEAM

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Introduction Proj

  • jec

ect Background nd Imp mpleme mentation Opera rati ting P Procedures Fa Facts & & Figur ures Challe llenges Summa mary Ref efer erenc nces

OUTL TLINE

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 Mental Health (MH) patients often present to rural EDs  Extended wait in ED MH assessment.  Stretched and under resourced Community Mental Health Services - limited response to EDs.  If no local MH service - patient need to be transported.  Limited transport options; none after-hours  Vast geographical distance – ED to MH Facility e.g. Grafton ED to Lismore is 131km or 1hr 34mins.  If transported & not admitted, patients are required to find their own way home.

PRE-NMHEC-RAP: A RURAL HOSPITAL PERSPECTIVE

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MH COMMISSION OF NSW - REPORT

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NSW SW Governm nment ent fund unded ed p projec ect

  • In response to “Living Well – A Strategic Plan” (Mental

Health C Commis issio ion n of NSW SW, 2014)

Esta tabli blish n new ment ntal h hea ealth r resour urce hub

  • staffe

fed - men ental h heal ealth p profes essio ionals,

  • operati

ting g 24 x 7 x 7

  • support r

rura ral l and remot

  • te c

communit ities o

  • f northern

NSW. W.

NMHE HEC-RAP AP is joint initi tiati tive

  • Hunter

r New E Englan and d LHD, ,

  • Mid

id North Co Coas ast LHD HD,

  • Northern

rn NSW SW LHD. .

NMHE MHEC-RAP RAP

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Medical l officers (in a n absenc nce o

  • f AM

AMOs) c can an do S Schedule 1 1 (s (s19A) an and F Form 1(s 1(s27A) via via videoconfere rence.

  • If can

an be be done w e with “ “sufficie ient s skil ill & & car are” e”

AMOs can u undertake e Form 1 1 asses essment ents at at a a decla lared M MH f facili lity ty of w which t they y are no not a an em n employee Accre redited Persons (AP (APs) can an d do Schedule le 1 ( (s19A) via a videoconfere rence

MH A MH ACT 200 2007 C 7 CHA HANGES -AU AUG 20 2015 15

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ORANGE GE WAGGA GA WAGGA GA

GOULBUR URN

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NE NEWC WCASTLE

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Menta tal H l Healt lth P Professionals ls p provide MH e expertise to regional al, r rural a and rem emote e EDs Ds where access ss to MH services s is n not r t readily ly availa lable le use video eo c conf nferenc ence to li link with E h EDs Utili lize ze a a consultat atio ion-li liaison mod

  • del i.e. ED

ED reta tains t the c clinical r l responsibili lity ty o

  • f t

the patie ient. .

NMHEC-RAP PRINCIPLES

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Builds on existing m models ls of mental health response to EDs NMHEC-RAP is an enhanc ncement of emergency mental health responses; It does not replace existing face-to-face MH input toEDs Hence, it com

  • mplement

nts face-to-face services and extends afte ter-hours rs c cover

NMHEC-RAP PRINCIPLES

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LHD Partnerships Hub & Spoke model Project manager – NSW MOH Project officers at LHDs How this was evolved

  • Consultation
  • Data gathering
  • Site Visits
  • Development of MOC and Operational Guidelines

PROJECT IMPLEMENTATION

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*

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Co-located with the Mental Health Line Recruitment & training of additional staff MH Assessment training – Role play Accreditation training - Mental Health Act Roll out – 4 sites initially, then on a schedule

PROJECT IMPLEMENTATION

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HOW DI W DID WE D WE SPREAD TH THE N NEWS?

A Fact Sheet was disseminated LHD wide in late February 2016 to introduce the Northern MHEC-RAP service. This flyer was distributed LHD wide via email just prior to Go Live.

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Identified site sent information – Operational procedures etc Site visit by NMHEC-RAP Dr & clinician Site visit by project coordinator – Telehealth Cart Go live! Regular feedback meetings – weekly -> monthly

PROJECT ROLL-OUT

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Loc

  • cated a

at the grounds o

  • f James

es F Fletcher Hos

  • spi

pital, N , Newcast astle Staf aff

  • Men

ental H Heal ealth P Profes essio ionals – multi ti-discipl plina nary

  • Med

edical s staf aff – Psyc ychi hiatrist 0 0.6 FTE & & Psych h Re Reg 1. 1.0 F FTE

Service Dire rector, T Team Manager & r & Clinical l Coor

  • rdinator

Project C Coordinato tor

NHME HMEC-RAP RAP H HUB LOCATI TION

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PHOTO JFH

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NHMEC-RAP ASSESSMENT ROOM

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WORKSTATI TION ON O ON W WHEELS “ “WOW” W”

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NMHEC-RAP Operational model

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What is a NMHEC_RAP assessment? A NMHEC-RAP assessment is a mental health assessment where you and the mental health professional are not in the same room as each

  • ther

and use technology to complete the assessment. Can a family member be with me during the assessment? NMHEC-RAP encourages family and/or carers to participate in the assessment, if this is your wish. You can choose any support person to be with you during the assessment. How will I see the mental health professional if we are not in the same room? The NMHEC-RAP assessment is conducted using a portable videoconferencing machine with a camera, audio and a screen. Can I ask questions during the consultation? You and your carer should feel free to ask questions at any time before, during and after the assessment. Why use NMHEC-RAP? A NMHEC-RAP assessment means that you will not need to travel to another hospital to be assessed. You may, however, need to travel to another hospital if you need to be admitted. What if I don’t want to be part of a NMHEC-RAP assessment? You may choose not to participate in a NMHEC-RAP assessment. Alternative arrangements will be discussed with you. Consent for the assessment You will be asked for your verbal consent before the assessment starts. What if I am uncomfortable during the NMHEC-RAP assessment? You can ask to stop the assessment at any time. Who will be part of the consultation? You will see the mental health professional

  • n the screen. There may also be a staff

member with you in the room if you do not a have support person and it is felt that you require one. All staff involved in the assessment will introduce themselves at the beginning of the session. Maintaining your privacy and confidentiality All NMHEC-RAP assessments are secure and subject to the same privacy requirements as face-to-face Health

  • services. The assessment will not be
  • recorded. The mental health professional

will take notes during the assessment which will be entered into your medical record, as would normally happen if you saw a Health professional face to face. How much will the consultation cost? This service is free for people presenting to emergency departments.

PA T IENT INFO RMA T IO N SHEET

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EMR(S)

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HNE - CHIME ACCESSIBLE VIA CAP

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GL GLEN EN IN INNES ES

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MH R MH ROOM

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INVERE RELL

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MH R MH ROOM

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Patient nts access ss speciali list t assessment nt a and ca care c clo loser to home; e; Red educ uce n e need ed to transp sport to MH facili lity ty for r men mental heal alth asses essment ent. EDs - reduc uce waiting ng t times for m r menta tal l heal alth assessment nts Com

  • mpreh

ehens nsive, c contempo poraneous, standardised e electr tronic cli clinical documen entat atio ion in EMR MR

BEN BENEF EFITS R REC ECAP

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Some Facts & Figures

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Com

  • mmenc

enced ed A Aug ugust 2016 Tota tal s l sites - 16 16 Total A Asses essmen ents – 1,325 FY 20 2017-18 - 956

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EXISTING MH ACTIVITY OF ED

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RECOMMENDATION FOR ADMISSION 26%

32 25 37 22.7 20 31 21 20 25.7 30 27 28.5 5 10 15 20 25 30 35 40

Percentage of Inpatient Referrals/Compared to Average

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TIME OF REFERRAL

10 20 30 40 50 60 70 80 90

Times of NMHEC-RAP Requests

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 All EDs have embraced NMHEC-RAP service  Staff are happy with the quality of picture and audio of the telehealth equipment.  ED Staff have provided positive feedback re standard

  • f assessment provided by the

Hub, particularly the high standard of documentation.  Feedback from patients using the service has been positive.

HOW IS NMHEC-RAP BEING RECEIVED?

Gra rafton B Base se H Hosp spital

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Challenges

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CHAL ALLENGES

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Chang nge m mana nagem ement nt Get etting ng u used t to t

  • tec

echno nology! Credibi bili lity o y of clinical a l advice g given by NMHE HEC-RAP AP staff f across ss s sites/ s/LHD HDs Differ erent ent d databases es and nd eM eMR sy systems across t the e LHD HDs. . Differ erent ent p pathways f for i interna nal (HNE) a and exter ernal al (MNC NC & NNS NSW) ) LHD HDs Medical c l credenti tiali ling & juri risdiction a across 3 L LHD HDs

CHAL ALLENGES

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Workf kflow – Unpre redicta tabili lity o ty of NMHEC-RAP APs refer errals Diver ersi sion f from n m non-NM NMHEC-RAP AP EDs Variations ns in proces esses a across s sites es. Contact w with S Staff f special alists s – vari rious proces esses f for

  • r LHDs,

, intra tra-LH LHD. D. Trans nsport & & bed f find nding ng

CHALLENGES

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IN THE END IT ALL COMES TOGETHER *

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Continuing Roll-out Hunter New England (Total ~26)

  • Merriwa, Murrurundi, Scone, Singleton,

Gloucester, Cessnock, Tomaree

Mid-North Coast

  • TBA

Northern NSW

  • TBA

NEXT SITES

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References

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 https://www.ra ranzcp.org rg/Publications/Telehealth- in-psychiatry.aspx  Saurman, E., Kirby, S. & Lyle, D. (2015). No longer flying blind: how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study. BMC Health Services Research. Vol 15:156.  Guidelines for the use of Telehealth for Clinical and Non Clinical Settings in NSW. https://www.aci.health.nsw.gov.au/__data/assets /pdf_file/0010/258706/ACI-telehealth- guidelines.pdf

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  • END

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