John Muir Health Behavioral Health Services Psychiatric Assessment and Liaison Services October 2, 2006

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John Muir HealthBehavioral Health
ServicesPsychiatric Assessment and Liaison
ServicesOctober 2, 2006
Elizabeth Stallings RN, Chief Operating
Officer Liz.stallings_at_johnmuirhealth.com
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John Muir Health

• Community Hospital 200 beds
• Trauma Center 320 beds
• Physician Network 700 physicians
• Acute Psychiatric Hospital 73 beds
• (child, adolescent and adult, Behavioral
  Health Adult Chemical Dependency and outpatient
  services)

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Overview of Services

• Psychiatric Assessment Services
• RNs respond to EDs within 1 hour of call
• Admit to Behavioral Health Hospital or transfer
  to other dispositions
• Inpatient Psychiatric Consultation
• Psychiatrists available daily to consult on
  medical patients with psychiatric/CD issues
• Liaison Nurse Service
• RN Clinical Specialist/Advanced Practice Nurse
  available for inpatient consultation to develop
  behavioral treatment plans with other clinicians
• Inpatient Chemical Dependency Assessment
  Consultation
• CD staff available to meet with inpatients
  regarding follow-up CD issues
• ASAM Certified Addictionologist
• Provides consultation for Inpatients and ICUs
  regarding detox protocols and chemical dependency
  complications
• Staff Training for Crisis intervention
• Emergency Department staff were trained in Crisis
  Prevention and Intervention (CPI). Certified
  trainers are now available to conduct regular
  trainings of ED staff

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Benefits

• Emergency Department Throughput
• Reduce LOS for Inpatient med-surg patients with
  behavioral health co-morbidities
• Decrease Staff Injuries and Anxiety
• Improve Patient Care
• Improve Patient Experience
• Increase Patient Safety
• Reduce Negative Outcomes (DTs, suicide attempts,
  agitation, etc.)
• Reduce liability regarding involuntary holds and
  the application of such
• Ensure consistent care for high risk patients

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Financial Arrangements

• Acute hospitals contract with Behavioral Health
  for the provision of Psychiatric Assessment and
  Liaison services
• Behavioral Health then contracts with independent
  psychiatrists for the provision of consultation
  services
• Behavioral health provides the nursing staff for
  assessment services

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Opportunities for Collaboration

• For Health Systems that do not have a behavioral
  health service or hospital, consider partnering
  with other hospitals or health systems for the
  components of a Psychiatric Assessment and
  liaison service.
• Collaboration with your county is also important.
  Hospital and county leaders should work together
  to ensure that psychiatric patients have access
  to community resources and care.
• As an example, hospitals, physicians and county
  health leaders formed a task force in our county
  to address the issue of involuntary holds and
  appropriate procedures to place patients on
  involuntary holds in our emergency departments
  throughout the county. Criteria were clarified,
  procedures were revised and a training program
  and video were developed to ensure consistent
  application of involuntary hold policies and
  procedures.

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Patient Containment