Wagga Wagga Mental Health Emergency Care Support Centre

Greater Southern Area Health Service

Abstract

The Wagga Wagga Mental Health Emergency Care Support Centre (MHECSC) established in July 2007, is an innovative technological solution to address the problem of poor timeliness and access to specialist mental health emergency assessment and support within the Wagga Wagga Base Hospital (WWBH) catchment area.  The Wagga MHECSC project is phase one of a roll out of three MHECSCs across GSAHS.  The MHECSC involves a specialist mental health emergency assessment centre co-located with the Base Hospital Inpatient Unit.  It utilises “internet protocol videoconferencing systems” to deliver specialist mental health emergency assessments to the catchment District and Community Hospitals.  It is a smart and sustainable choice to address the unique rural issues that the GSAHS faces due to its large geographical area and consequent recruitment limitations.

 Download the presentation given at the 2008 NSW Health Expo (1 KB).

Aim

To improve the patient journey for those accessing emergency mental health services by: 

1. Ensuring 24-hour access to specialist mental health assessment services.
2. Providing specialist mental health assessment and support to district and community Emergency Departments (EDs) utilising videoconferencing technology from WWBH.

Nature of the Problem

Recruiting specialist mental health practitioners to rural areas is becoming increasingly difficult.  This difficulty is highlighted during emergencies when patients present to EDs in the acute phase of their mental health illness.  Without timely access to specialist mental health assessments at such a time, the safety of the patient, and potentially others, can be significantly compromised. 

The Area Health Service covers 166 608 square kilometres and services 44 District and Community Hospital EDs and three Base Hospital EDs.  This vast distance and the challenges of sourcing specialist personnel results in the need for patients to travel large distances to sites where specialist mental health emergency services are available.

A smarter choice in delivering specialist mental health emergency care was required to improve access and timeliness of patient care.  A NSW Government initiative allocated recurrent funding to emergency mental health services including GSAHS and hence was the catalyst for this initiative. 

Extent of the Problem

A Steering Committee was established in 2005 comprising key stakeholders from Critical Care, Mental Health and user groups (District and Community Hospital representatives).  The Committee flowcharted the journey of mental health patients requiring emergency services within GSAHS and brainstormed problems patients might experience navigating through services at District and Community Hospitals, Base Hospital and Mental Health Inpatient Units including assessment, treatment, admission and transfer procedures.

This Committee identified key issues affecting timely access to mental health emergency care.  These key issues were in the area of education, transport, and staffing.  Solutions to these key issues were then canvassed. 

The MHECSC (mental health emergency care support centre) proposal was developed to address the issues identified as the main barriers to access and timeliness of care.  This solution maximised the opportunities provided by technologies that were now available to improve access to services through centres where mental health specialist services were based. 

The MHECSC proposal involved the establishment of assessment centres co-located with each of the three mental health inpatient units (MHIUs) in Wagga Wagga, Albury, and Goulburn, and staffed by experienced mental health clinicians.  Further, these assessment centres would provide specialist assessment and support to consumers presenting to District and Community Hospitals by utilising video conferencing technologies.

Strategic Importance

The MHECSC project relates to NSW Health strategic direction (5) “make smart choices about the costs and benefits of health services”  .  This project makes effective use of finite resources by developing more sustainable services and infrastructures considering the limitations of our rural geography and consequent recruitment issues. 

MHECSC also addresses a key objective in the GSAHS Mental Health Clinical Services Plan (2005:5): “improving service availability across the population spectrum”.  

Similarly, MHECSC assists GSAHS in meeting several key performance indicators (KPIs) in the area of Emergency Admission Performance.  These include benchmark targets for access to Mental Health Inpatient Units via EDs, and waiting times in EDs for mental health patients. 

Planning and Implementation Solutions

The MHECSC project was divided into three phases.  The first phase commenced in July 2007 and involved the roll out of the assessment centre at Wagga Wagga Base Hospital (WWBH).  Videoconferencing technology was installed and sessions commenced to the District and Community Hospitals within the WWBH catchment area from October 2007. 

Phase 2 involved the development of the Albury MHECSC and roll out of the videoconferencing technology to its 11 catchment District and Community Hospitals.  This has commenced and is planned to be fully implemented by the end of June 2008. 

Phase 3 involves the development of the Goulburn MHECSC and roll out of the videoconferencing technology to its catchment District and Community Hospitals.  This final phase of the project is expected to be completed by the end of 2008. 

Each phase involves:

• The installation of internet protocol videoconferencing systems into the MHECSC base sites (3) and then the corresponding catchment District & Community Hospital sites (43 in total).
• Recruitment of mental health specialists to the MHECSC co-located site.

A project manager was appointed to implement all phases of the MHECSC project.  The Mental Health Executive has maintained governance of the project throughout its implementation.  This project required close collaborations internally between the Mental Health Service, Information Technology Service, Asset Management, and District and Community Hospital staff, and externally with the videoconferencing consultants. 

A Working Party was established comprising key stakeholders to assist in the development and implementation of the project.  Communication on the progress of the project occurred via this working party with fortnightly updates monitored through the Mental Health Executive Committee.  Regular teleconferences were held, meeting minutes and documents circulated for comment, and memorandums and project schedules disseminated.

Patient journey activity of consumers accessing the Wagga MHECSC was monitored on a weekly basis through a collaborative Mental Health and Critical Care Redesign Initiative.   

Outcomes and Evaluation

1. Ensuring 24-hour access to Mental Health specialist assessment at WWBH. 

A MHECSC policy and procedure was developed through consultation within GSAHS and externally to General Practitioners. 

From July 06 to April 07, there were 386 patients admitted to the Mental Health Inpatient Unit (MHIU) at WWBH compared with 464 for the same period 07/08 (20.2% increase).

• NSW Health has set benchmark targets requiring that 80% of patients accessing the MHIU should progress through the ED within 8 hours.  During 06/07, the benchmark was met once with an average of 70% over the year (figure 1). 
• Since MHECSC in July 2007, an average of 90% of patients accessed the MHIU within 8-hours (20% improvement).

There has been an increase of 3% in the number of patients presenting to WWBH ED from 793 in 06/07 to 817 in 07/08.

• For 06/07 the average time spent in the WWBH ED was 6.88hrs.
• Since MHECSC, the average time spent in has reduced to 3.8hrs (44.9% improvement - figure 2).

2. Providing assessment and support to the District and Community EDs in WWBH catchment area outcomes are as follows:

In the WWBH Catchment area District and Community Hospitals, there has been a reduction of 23.1% of patient admissions from 324 (November 06 to April 07), to 233 for the same period 07/08 (figure 3).

• For the 6-month period, there were 70 patient transfers to WWBH ED.
• Following MHECSC, there were 42 patient transfers (40% decrease) resulting in less patient disruption.

There has been a reduction in both ED and Hospital discharges at most sites since MHECSC commenced. 

Figure 4 shows an increasing trend in utilisation of MHECSC by Community and District Hospitals whilst figure 6 shows that of 92 patients receiving a MHECSC service between November 07 and April 08, 43% were discharged home, 36% were managed locally, and 15% were transferred to MHIUs.

Sustaining Change

Evaluation of the MHECSC service has been completed for the first 6-month period.  As the project continues and expansion occurs to the other two MHECSC services (see below), ongoing evaluation will ensure these improvements are sustained and any necessary adjustments undertaken.

Monitoring of activity of the MHECSC service occurs through an Area redesign group with local, Area ED, and Mental Health representation.  This group problem solves any issues that arise through each patient journey and closely monitors progress against the State Key Performance Indicators.  Most importantly, there are several examples of successful patient journeys from patients, their families, and staff, due the MHECSC service.  

This project is occurring concurrently with other initiatives between Critical Care and Mental Health.  The combination of all these initiatives assists in ensuring the sustainability of these improvements in patient care. 

Future Scope

Phase 2 of the MHECSC project is currently underway.  Videoconferencing facilities are being installed into 11 Community and District sites that comprise the Greater Albury sector catchment.  This will be completed by end June 2008 when the Albury MHECSC will be fully operational.   

Phase 3 of the MHECSC project will involve a further expansion to Community and District sites linked to the Goulburn MHECSC.  This will be undertaken once phase 2 has been completed.

There is a potential that this videoconferencing medium could be utilised by other services within the GSAHS.  Similarly, other rural Area Health Services both within NSW and within QLD have also expressed an interest in our MHECSC project. 

References

• NSW Health 2007.  A new direction for NSW.  State Health Plan Towards 2010.
    http://www.health.nsw.gov.au/pubs/2007/pdf/state_health_plan.pdf
• GSAHS Mental Health Clinical Services Plan. 2005.
• Mental Health Emergency Care Support Centre Policy & Procedure 2008.GSAHS.

Contact

This project was entered in the 2008 NSW Health Awards, Make Smart Choices about the Costs and Benefits of Health Services category.