Rapid Recovery Referral The Warm Handoff. Charles F. Barbera, MD, MBA, FACEP, FAAEM Chairman Department of Emergency Medicine

Transcription

1 Rapid Recovery Referral The Warm Handoff Charles F. Barbera, MD, MBA, FACEP, FAAEM Chairman Department of Emergency Medicine

2 Disclosures No relevant financial disclosures 2

3 Objectives Define rapid recovery referral for Emergency Department patients Describe techniques to assist in the success of the rapid referral program Discuss barriers encountered during implementation 3

4 4

5 A Collaborative Effort 5

6 Tower Health 1,500 beds Health System in South Eastern Pennsylvania Hospitals Include: Reading Hospital Brandywine Hospital Chestnut Hill Hospital Jennersville Hospital Phoenixville Hospital Pottstown Hospital Connected network of more than 2,000 physicians, specialists and providers across 65 locations More than 11,000 employees Also include Reading Hospital Rehabilitation at Wyomissing, Reading Hospital School of Health Sciences 6

7 Reading Hospital 7

8 Reading Hospital Independent Academic Center 735 licensed-bed teaching hospital Serves a population over > 410,000 ANCC Magnet Recognition Over 135,000 ED visits yearly Level 2 Trauma Center accredited by Pennsylvania Trauma Systems Foundation Nationally recognized for clinical outcomes and quality Distinguished hospital for Clinical Excellence in Healthgrades for 3 consecutive years, Top 100 Hospitals Recent Accreditation for an Emergency Medicine Residency 8

9 Defining the problem 2,500 drug overdose deaths in 2014 in PA Over 3,500 deaths in drug related deaths in Berks County in heroin related deaths in Berks County in in in 2015 Reading Hospital Average 3 opioid overdoses daily Combination of heroin/fentanyl/prescription medications 9

10 Number and age-adjusted rates of drug overdose deaths by state, US

11 Drug Overdoses in PA Counties 11

12 Percent Change in Drug-Related Deaths 12

13 Berks County 13

14 Act 139 September 2014 David s Law Allows first responders or other organizations, acting at the direction of health care professionals authorized to prescribe naloxone, to administer the drug to individuals experiencing symptoms of opioid overdoses. 14

15 Act 139 Since passage of law there have been Over 3,000 reversals by law enforcement 15

16 Naloxone 16

17 What happens next?????? 17

18 Emergency Department Treatment Car vs Ambulance ABCs Appropriate laboratory testing Admission vs Referral? 18

19 In the past before 2015 Physician stabilizes the patient Offers recovery program If no beds, patient was given referral to Treatment Access and Services Center (TASC) Go to TASC at 8 AM First come, first serve Printed instructions 1

20 2

21 Cardiac Catheterization 3

22 Transition our thought process 4

23 Current process 2017 Physician stabilizes the patient ED Physicians orders a Warm Hand-Off in EPIC Recovery specialist meets with the patient in the ED to develop a recovery and treatment plan 5

24 Reading Flow Diagram 6

25 Ordering process in EMR 7

26 8

27 3 Years in Recovery PA CRS Certification Experience, Strength & Hope 9

28 W.H.O. Interventions 10

29 Permission Reflective Listening Open Ended Questions Affirmation Roll with Ambivalence Summarize Plans 11

30 Pennsylvania ACEP 12

31 Barriers Buy in from ED staff Buy in from patients Communication Lack of resources 13

32 14

33 15

34 Buy in from Emergency Staff Difficult patient population Difficult conversations Treatment failures Resource availability Metrics Length of Stay Productivity 16

35 Buy in from Patients History of difficulty with the system Recovery-ready? Trust 17

36 Communication Hospital communication with outside resources Staff communication Patient communication 18

37 Resources Bed availability Dual Diagnosis Recovery specialists Survey May, 2016 Lack of beds and facilities 19

38 Interventions per Month On-Call 39 Hospital-Based 20

39 60 Interventions per Month (Jun-Jul-Aug 2017) OTHER OPIATES 10 0 JUNE JULY AUGUST 21

40 80% Treatment Admissions 70% 60% 50% 60% On-Call 72% Hospital-Based 22

41 CC On-Call (2/16-5/17) 32% Male 68% Female 23

42 Hospital-Based (Jun-Jul-Aug 2017) 32% Male 68% Female 24

43 4% Ethnicity Hospital- Based (June-July-Aug 2017) 28% 68% White Latino African American 25

44 Age On-Call (2/16-5/17)

45 Age Hospital- Based (June-July 2017)

46 Warm Handoff Timeline Late 2015 Approached by Council on Chemical Abuse Dec 2015 ED physician education Dec 2015 Initiated Warm Handoff Program at Reading Consult placed with hard stop in order set May 2016 Electronic report created in EMR August 2016 Center of Excellence April 1, /7 in house CRS July 1, CRS handle Opiates and Alcohol and Cocaine 28

47 Results Since December referrals for rapid recovery at Reading Hospital Approximately 13 patients per month Positive feedback from staff and patients 29

48 Berks County Warm Hand Off December 2015-August, 2017 Percentage of Overdose Survivors admitted to treatment - 62% Overdose Survivors Treatment Admissions- 44 Detox 2 MAT 2 Outpatient Percentage of those in severe withdrawal admitted to treatment-51% Severe Withdrawal - No Overdose Treatment Admissions 57 Detox 2 MAT Percentage of both OD and Severe Withdrawal admitted to treatment - 56% 30

49 Team Effort 31

50 Thank you! 32