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Thursday, December 7 • 4:30pm - 5:30pm
Poster Session: Transition of Psychiatric Care: From Psychiatric Emergency Services (PES) to Community with Peer Support

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Introduction: Psychiatric emergency services are used by individuals undergoing mental health crisis, but many patients fail to transition to outpatient care. Instead, many of these patients return to the emergency settings for additional care. Barriers such as the patients’ own psychiatric symptoms as well as navigating the complex mental health care system often prevent patients from receiving ongoing psychiatric care outside of the emergency department. Data from the University of Cincinnati’s (UC) Psychiatric Emergency Services (PES) reported a 17.4% patient recidivism rate within 30 days between March and April 2023. Aim: The primary aims of this project are to 1) initiate a peer support programs’ follow-up call system that is intended to transition patients from PES to community outpatient care, 2) target discharged psychiatric patients that do not meet inpatient admission criteria and 3) evaluate patients' use of peer services for future targeted interventions. Intervention: Using the Plan-Do-Study-Act (PDSA) Model of Improvement, peer specialists made follow-up calls for PES patients within 24 hours of the patient’s discharge. Peer specialists consist of a team of non-clinical individuals who have experience in either mental health or substance abuse recovery (David et al. 2012). They are trained to guide, support, and advocate for patients through the adherence of the Substance Abuse and Mental Health Administration (SAMHA) guidelines (Chinman, 2014). During these follow-up calls, peer specialists asked patients if they needed assistance with connecting to outpatient mental health services. Only patients that were discharged into the community from UC Health’s Ridgeway PES that did not meet criteria for in-patient psych admission nor were transferred to another medical facility were qualified for the follow-up calls. For this project peer specialists documented who they called, the number of calls attempted to contact patient, who answered call, if peer services were used, and if patient scheduled a future outpatient appointment with mental health services. Patients’ psychiatric history, demographics, emergency department encounters, and clinician notes from the designated PES visit were collected from the patient’s medical recorder via EPIC Systems. Data Collection and Analysis: Between June 25th through July 2nd, 2023, approximately 10 discharged patients from the previous day were randomly selected to receive follow-up calls from a peer specialist to offer help with discharge instructions and connecting to outpatient mental health services. Only patients that were discharged into the community from UC Health’s Ridgeway PES that did not meet criteria for in-patient psych admission nor were transferred to another medical facility were qualified for the follow-up calls. For this project peer specialists documented who they called, the number of calls attempted to contact patient, who answered call, if peer services were used, and if patient scheduled a future outpatient appointment with mental health services. Patients’ psychiatric history, demographics, emergency department encounters, and clinician notes from the designated PES visit were collected from the patient’s medical recorder via EPIC Systems. Discussion: This project was preformed to analyze the preliminary stages of the peer program and establish the groundwork for carrying out the Plan-Do-Study-Act (PDSA) Model of Improvement to target patients with 1) high psychiatric symptom burden and 2) a pattern of not connecting with outpatient services. The results of this project showed that phone calls were an effective method to follow up with discharged patients. This information is aligned with a similar study that did follow up calls after ED discharges in which they reported 66.7% of discharged patients were able to be reach via telephone within one phone call (Biese et al., 2014). However, in the current project, only a third of patients utilized their peer services to connect with outpatient mental health resources. even though a majority of the patients were not connected with outpatient mental health services. The low number of patients using the peers service could be due to the fact that data was collected a week after services were first launched; therefore, patients may not have been aware of the new program. Therefore, the Plan-Do-Study-Act (PDSA) Model of Improvement will be used in the future to not only continue monitoring peers support progress but also to target patient populations that would most benefit from follow-up calls by transitioning from randomly selected discharge patients to clinician- selected discharged patients.

Learning Objectives:
  1. Patients who make use of Psychiatric Emergency Services often have many barriers to getting linked with out-patient services. A concern is patients continue to have have Psychiatric symptoms or return to hospital settings
  2. Peers support Services are a option to help patients navigate the mental health system.
  3. PDSA quality improvement projects may be a way to target patient populations who have greatest need for peers support to make out patient care connections


Speakers
avatar for Bryan Griffin, DO, MHA

Bryan Griffin, DO, MHA

Medical Director PES, University of Cincinnati Department of Psychiatry
Dr Bryan Griffin is Medical Director of The Psychiatric Emergency at The University of Cincinnati for over 20 years. During this time he has implemented protocols to improve patient and staff safety, improve patient flow, and trained Medical Students and Residents in Psychiatric Emergencies... Read More →



Thursday December 7, 2023 4:30pm - 5:30pm PST
Vendôme C