A pilot project that began earlier this year is increasing quality of patient care and safety by decreasing re-admissions of clients with psychiatric concerns to the emergency department, translating into a cost savings of more than $100,000 for Saskatoon Health Region.

In February, the Region launched a pilot to expand the hours of Royal University Hospital’s (RUH’s) mental health transition team to include evenings and weekends in support of clients with psychiatric concerns who would otherwise have had to visit RUH’s emergency department during off hours. The transition team is now available until 11:30 p.m. Monday to Wednesday and until 10 p.m. Thursday to Sunday.

Royal University Hospital and the Dubé Centre.

Royal University Hospital and the Dubé Centre.

From April 1 to October 31, 2015, the transition team’s extended hours contributed to the prevention of 463 visits to RUH’s emergency department through the team’s support of clients with psychiatric concerns. At a cost of $243 per visit to the emergency department, the team has saved the Region $112,509 in the past eight months. During this same period, the team has also increased the number of clients with psychiatric concerns who are engaged in community services by 80 per cent, from an average of 20 client referrals per month to an average of 70 referrals per month.

The role of the transition team, comprised of social workers, community mental health workers and community mental health nurses, is to follow up with referred clients within 24 hours of discharge from the emergency department or Dubé Centre to provide them with support, education, information and referrals to community agencies. In addition, the team provides support with medication and symptom management, liaises between clients and physicians, and provides assistance with practical supports such as finding housing, advocacy, applications for financial assistance, transportation to appointments and medication pick up from the pharmacy.

Prior to expanding the team’s hours, this support was not available on evenings and weekends – when psychiatric visits to hospital emergency departments are at their highest – and many clients were being re-admitted to the hospital as a result.

“We know that any transition in care from hospital to the community is the highest risk time for our clients,” says Tracy Muggli, Director of Mental Health and Addictions Services, Saskatoon Health Region. “If you don’t have a solid plan and continuity of care in place, the client is more likely to have another incident and end up back in hospital, so this bridging of care is critical to their safety and mental health.”

Previously, some clients were presenting to the emergency department on Friday, and again on Saturday and Sunday because of the gap in care on evenings and weekends.

“The majority of our clients are adults 18 and over who are either diagnosed with a mental illness like depression or experiencing a crisis in their personal lives that causes suicidal thoughts and this leads them to our emergency department,” says Liz Letwiniuk, RN, community mental health nurse with the team. “For many, it’s their first time visiting the emergency department with a mental health concern, so it can be daunting to return home in the evening or on a weekend and not have a care provider available to assist with their needs.”

In November, the team also added an extra part-time social worker on Friday and Monday to assist with emergency department (ED) surges of clients with psychiatric concerns. The role of the social worker is to assist RUH’s Psychiatric Liaison Nurse to assess  patients’ needs  in the ED during a surge; to ensure that before a patient is admitted to Dubé, all other community resources have been considered; to facilitate a seamless transition for the patient from the ED to Dubé; to meet with the social workers at Dubé on Monday to share information and assist with the admission process; and to resolve any issues that could interfere with the patient’s discharge from Dubé.

Within the past month, the addition of the part-time social worker has prevented two unnecessary admissions to the Dubé Centre. At a cost of $595 per day – with an average length of stay in Dubé of 19 to 25 days – the potential cost savings are in the range of $22,610 and $29,750 in less than one month.  Most importantly, it has allowed clients to receive the care they need while remaining in their home community.