JOHN GEORGE PAVILION
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1 JOHN GEORGE PAVILION PSYCHIATRIC EMERGENCY SERVICES (PES) CAPACITY ISSUES: Causes and Potential Solutions SYSTEM UPDATE Board of Supervisors Health Committee September 26, 2016 Rebecca Gebhart, Interim HCSA Director Karyn Tribble, PsyD, LCSW, BHCS Deputy Director Guy C. Qvistgaard, Chief Administrative Officer, John George Psychiatric Hospital / Ambulatory Care, Alameda Health System
2 JGP PES - Capacity Issues: Causes & Potential Solutions 2 Review JGP PES & Inpatient JGP PES The Psychiatric Emergency Service (PES) provides psychiatric evaluation, intervention and referral for both voluntary and involuntary patients 24/7. Crisis intervention and urgent medication assessments provided. An individual may stay in PES for up to 24 hours. JGP Inpatient Services The John George Psychiatric Hospital has a total of 80 licensed Inpatient beds (69/80 currently available for use). Inpatient Admissions: 3,077 (Average Length of stay = days)
3 JGP PES - Capacity Issues: Causes & Potential Solutions 3 Review JGP PES Overview Background JGP PES Overview Background Acuity and Utilization
4 JGP PES - Capacity Issues: Causes & Potential Solutions 4 UDATE JGP PES Data Analysis 31 days before Intervention: (5/24/2016-6/23/2016) 31 days after Intervention: (6/24/2016-7/25/2016) Number of PES Patients per day (includes >24hrs) = 55.7 Number of PES Patients per day (includes >24hrs) = 46.5
5 PES Volumes Before and After Intervention 31 days before Intervention: 5/24/2016-6/23/ days after Intervention: 6/24/2016-7/25/2016 Number of PES Patients per day (includes >24hrs)
6 PES Data as of 7/25/2016
7 PES Volumes Before and After Intervention 31 days before Intervention: 5/24/2016-6/23/ days after Intervention: 6/24/2016-7/25/2016 Number of PES Patients per day (includes >24hrs)
8 July - Date PES (Reg+>24hr) JGPH Inpt Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday Monday Tuesday Wednesday Thursday Friday Saturday Sunday 25 0 Monday 26 0 Tuesday 27 0 Wednesday 28 0 Thursday 29 0 Friday 30 0 Saturday 31 0 Sunday MTD 1,137 1,633 ADC
9 *Change in PES provider staffing (including Triage) occurred on 6/24/2016 PES Volumes (includes >24hrs) 53.2 March 56.6 April 56.8 May 51.2 June* 47.4 July MTD
10 65 Average Pt Census in PES (includes pts staying >24 hours) Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16
11 PES Daily Visits - rolling 12 months Green bars = # of registered visits Blue bars = total pts (registered visits + pts staying over 24 hours) Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 July MTD
12 35.0 Average Length Of Stay (LOS) in PES (in hours) 30.0 Hours Goal <24.0 hrs Jul y Aug Sep t '13 Oct Nov Dec Jan Ma Jun Jul Feb Mar Apr '14 y e y Aug Sep Oct Nov Dec Jan Ma Feb Mar Apr t '15 y Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Ma y Hrs Jun Jul MT D
13 JGP PES - Capacity Issues: Causes & Potential Solutions 13 CAUSES of Capacity Issues & Overcrowding A Culture of Care CULTURE OF CARE Delays in Treatment CAUSES Step-Down Resources in Community Space Capacity In-Patient Beds
14 JGP PES - Capacity Issues: Causes & Potential Solutions 14 CAUSES of Capacity Issues & Overcrowding Delays in Treatment Culture of Care CAUSES DELAYS IN TREATMENT 31 days BEFORE Intervention: (5/24/2016-6/23/2016) Number of PES Patients per day (includes >24hrs) = days AFTER Intervention: (6/24/2016-7/25/2016) Number of PES Patients per day (includes >24hrs) = 46.5 Step-Down Resources in Community Space Capacity In-Patient Beds
15 JGP PES - Capacity Issues: Causes & Potential Solutions 15 CAUSES of Capacity Issues & Overcrowding Space capacity in PES Culture of Care Delays in Treatment CAUSES Step-Down Resources in Community SPACE CAPACITY In-Patient Beds
16 JGP PES - Capacity Issues: Causes & Potential Solutions 16 CAUSES of Capacity Issues & Overcrowding Inpatient beds Capacity Culture of Care CAUSES Delays in Treatment Step-Down Resources in Community Space Capacity INPATIENT BEDS
17 JGP PES - Capacity Issues: Causes & Potential Solutions 17 CAUSES of Capacity Issues & Overcrowding Step-Down Resources in Community Culture of Care CAUSES Delays in Treatment STEP-DOWN RESOURCES IN COMMUNITY Space Capacity In-Patient Beds
18 JGP PES - Capacity Issues: Causes & Potential Solutions 18 MULTIPLE COMPLEX CAUSES. REQUIRE MULTIPLE TYPES OF SOLUTIONS
19 JGP PES - Capacity Issues: Causes & Potential Solutions 19 Potential SOLUTIONS to Capacity Issues & Overcrowding - PES Staffing Expand JGP Capacity PES STAFFING POTENTIAL SOLUTIONS Existing Resources Community resources ED Tele- Psychiatry Pilot JGP to add additional Triage Doctors to screen and stabilize clients Increase will enable patients to be screened 20 hours / day, seven days per week. Rapid screening, assessment, and coordination of care can occur and possibly divert patients to more appropriate levels of care. Status Effective June 24, 2016
20 JGP PES - Capacity Issues: Causes & Potential Solutions 20 Potential SOLUTIONS to Capacity Issues & Overcrowding - Community Resources Expand JGP Capacity PES Staffing POTENTIAL SOLUTIONS Existing Resources COMMUNITY RESOURCES ED Tele- Psychiatry Pilot Increase community capacity for step down services Pilot Short-Term treatment program to provide continuity of care and intensive postdischarge treatment in community. Two SB82 capital projects underway expected to open months. Explore shorter term options
21 JGP PES - Capacity Issues: Causes & Potential Solutions 21 Potential SOLUTIONS to Capacity Issues & Overcrowding - ED Telepsychiatry Pilot PES Staffing POTENTIAL SOLUTIONS Community Resources Approve EDs to extend and release 5150s Status: St. Rose pilot underway Expand JGP Capacity Existing Resources ED TELE- PSYCHIATRY PILOT Consideration for San Leandro and Alameda Hospital
22 JGP PES - Capacity Issues: Causes & Potential Solutions 22 Potential SOLUTIONS to Capacity Issues & Overcrowding - Existing Resources PES Staffing Community Resources Strategic use of existing resources: POTENTIAL Sobering Center Expand JGP Capacity SOLUTIONS EXISTING RESOURCES Ed Tele- Psychiatry Pilot Recovery residences Emergency housing options
23 JGP PES - Capacity Issues: Causes & Potential Solutions 23 Potential SOLUTIONS to Capacity Issues & Overcrowding - Expand JGP Capacity PES Staffing Community Resources Capital project to increase inpatient beds and PES footprint Cost +/- $30M EXPAND JGP CAPACITY POTENTIAL SOLUTIONS Ed Tele- Psychiatry Pilot Status Plans explored in 2013, no movement due to need to secure funding. Existing Resources
24 JGP PES - Capacity Issues: Causes & Potential Solutions 24 NEXT STEPS Short-Term Action Items (6-18 Months) Long-Term Planning & Action Items (12 Months +) Additional Triage Doctors at PES SB82 Grant Awards (CSU s & CRT s) Stable Psychiatrist Staffing JGP Inpatient & PES Capital Expansion St Rose Tele-psychiatry Use of Wellness Centers & Other Community Based Resources at Discharge
25 QUESTIONS? JGP PES - Capacity Issues: Causes & Potential Solutions 25
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