AIM:  Create a learning community to Improve Operational and Clinical outcomes for persons suffering mental illness and substance use cared for in the Hospital Emergency Department; Test a package of ideas to achieve ambitious performance targets for the following:

·                Improved patient and staff safety

·                Reduce coercion – especially the use of restraint and seclusion

·                Stewardship of Resources/operations: Achieve a reduction in length of stay for patients discharged from the ED; Achieve greater reduction for Fast Track patients, and achieve other intermediate standards of care.

·                Reduction in percent of patients returning to the ED within 8 hours, one week, two weeks and 30 days.

·                Increase patient and staff satisfaction with behavioral health care as measured by instruments of satisfaction established by the hospital.

·                Reduce Costs: For length of ED stay, for “boarder” costs and for costs of return visits

Co-Chairs

Tammy L. Powell, FACHE	Stuart Buttlaire, PhD, MBA
Vice President and Chief Nursing Officer	Regional Director
Behavior Medicine	Inpatient Psychiatry & Continuing Care
St. Anthony Hospital	Kaiser Northern California
Oklahoma City, Oklahoma
Director	Improvement Advisor
Peter Brown	Alden (Joe) Doolittle
Co-Executive Director	Co-Executive Director
Institute for Behavioral Healthcare Improvement	Institute for Behavioral Healthcare Improvement

Faculty
Jon S. Berlin, MD	Medical Director Crisis Services, Milwaukee County Behavioral Health Division, Milwaukee, WI
David Hnatow, MD	Medical Director University Hospital Emergency Center, Chief of Staff, University Health System, San Antonio, TX
Darcy Jaffe	ARNP Psychiatry Director, Harborview Medical Center, Seattle, WA
Steve Miccio	Executive Director, PEOPLe Inc., Poughkeepsie, NY
Susan Stefan,J.D.	Center for Public Representation, Newton, MA

IBHI is sponsoring a Briefing Call on December 5, 2007. Click here for more information on this Briefing Call.

First Learning Session January 27-29, 2008 Windsor Court Hotel, New Orleans, LA

Deadline for enrollment is December 14, 2007.

Here is a letter from Michael F. Hogan, Ph.D., Commissioner, Office of Mental Health, State of New York, announcing that his office is now a charter member of IBHI, and is looking forward to working with IBHI on this collaborative on improving care for behavioral health clients in emergency departments.

Overview of the Collaborative Process

IBHI believes the most intensive and needed learning about improvement occurs in learning and innovation communities, where teams from participating organizations with a will to implement changes, come together to share and learn good ideas. These are collaborative change laboratories in which teams from a wide variety of organizations work with each other and IBHI faculty to rapidly test and implement meaningful, sustainable change within a specific topic area.  In IBHI’s initial effort this will be care provided Behavioral Health Clients in hospital Emergency Departments.

Innovation Communities provide results-focused collaborative improvement opportunities to teams with a wide range of content and improvement experience.  Participants start with in-depth diagnostic and goal-setting processes, and identify initial areas of focus based on their expertise in the topic and in improvement.  Teams engage in rapid testing of changes that have been shown to improve care, adapting them to their own settings, and constantly measuring the outcomes.

Learning takes place in a variety of settings:

• In-person meetings three times in a year with faculty and participating teams
• Virtual learning using WebEx several times per year
• Structured teleconferences at least monthly
• Self-paced online learning
• Listserv communication available all the time to all team members and faculty.

Background and Context for the ED Collaborative 

Since 1999 the Institute of Medicine (IOM) has issued several significant Reports calling for dramatic improvement in health care.  Published as a Crossing the Quality Chasm Series, they have pronounced that the Healthcare System is in need of improvement and re0design. They included specific references to hospital, primary and specialty medical care, Emergency Department and Behavioral Health Care.  Above all in their recommendations they establish six characteristic s for the re-designed system. 

Making these and parallel recommendations operational on a wide scale can prove daunting even when the need is so apparent.  As a not for profit, committed to dramatically improving behavioral health care outcomes, IBHI views the situation in the Emergency Department as an area for early attention and progress.  The Emergency Department (ED) is viewed as the “Canary in the Mine” for a general and behavioral health care system which is having trouble meeting client needs.  There is wide consensus on the need for improvement, few clear best practices, and difficulty integrating care.  The ED is in need of improved internal, as well as external, system and community-minded connections and redesign efforts.  There is debate over whether internal or external approaches are the logical point of beginning to implement and spread changes.   IBHI believes there is an important opportunity to demonstrate the applicability of a proven method in this area, the Breakthrough Series Collaborative (BTS), pioneered by the Institute for Health Care Improvement (IHI).

A BTS Collaborative brings together organizational team leaders where there is a strong will to make changes and achieve higher learning in a community.  Over a finite time period, nine months, they will be supported with “good ideas” drawn from healthcare and other industries in piloting these ideas, and learning from others making these changes.  Above all, sharing results through telephone, internet, and live connection will make the process a continuing learning enterprise.  The “fulcrum” and “lever” of the BTS is a “change package” of good ideas and the application of a simple yet robust Model for Improvement.  It encourages participants to start at small scale pilots of change and spread results to the larger organization and others.

IBHI could discern no existing “Change Package” for improving care of patients requiring Behavioral Healthcare in the ED.  IBHI has used an existing “package” from an existing Institute for Healthcare Improvement ED collaborative in general health care as the starting point.  It convened an Expert Panel (6/27/07) and adapted and expanded this into a working “change package” for Behavioral Healthcare in the ED.

Scope of the Collaborative

This Collaborative will focus on simplifying the behavioral health patient's interaction with the Emergency Department portion of the health care system.  In effect they will also “test” the change package and provide a base for further collaborative learning by successive organizations. The focus will be on areas for improvement internal to the Emergency Department, that “they and only they” that is the patient, the family, and involved friends, can experience and report.  It is anticipated there will be a future collaborative to address additional aspects of improving integration and collaboration of community and general hospital care for behavioral health clients. Participant organizations in the first collaborative will be given the first opportunity to participate in a follow up collaborative to explore and develop the next stage of improvement.

Major themes of the collaborative are:

1) Create a team atmosphere in the ED between patent clients,  general and behavioral health staff.

2) Establish a welcoming environment in the ED since the environment will help reduce the amount of agitation and therefore the need for other interventions, such as restraint and seclusion, and simplify treatment. Consider use of peer counselors in this effort.

3) Develop open communication expectations with clients and between behavioral and general healthcare staff.

4) Address general health needs and behavioral health needs in parallel and interconnected tracks, so neither part must wait on the other.

5) Develop standard protocols ahead of time for assuring placement planning and follow up to begin immediately upon presentation by client.

6) Develop standard protocols for assuring full assessment and appropriate disposition. Reduce admissions or restraint or seclusion to essential cases.

7) Keep track of results, and implement changes slowly and carefully but with increasing intensity and spread.

THIS COLLABORATIVE

The collaborative will begin with a learning session on January 27-29, 2008.