SECTION 2
Client Care and Service
Community Focused
Continuing Care
Emergency/Trauma
Maternal, Child & Youth
Medical Care
Mental Health
Palliative Care
Specialized Intensive Care
Surgical Care

SECTION 3
Support Services
Information Management
Human Resources
Physical Environment

SECTION 4
Leadership/Partnership
Strategic Directions
Implementing Strategic Directions

Relationships with tertiary care facilities and continuing care facilities are excellent and referral processes work well. Internal communication with all disciplines is equally good, and external communication with community based services is improving. While there does not appear to be any duplication in service provision, documentation particularly regarding assessments is sometimes duplicated and encouragement is offered to work toward a comprehensive and integrated assessment tool.

Almost all clients requiring medical care are first seen in the emergency services. This can create back ups with clients experiencing long wait times for a bed. A review of current processes for admission and length of stay is suggested, as better utilization management of beds might decrease congestion in the emergency department.

Client orientation starts with the acute care admitting nurse and continues with other disciplines such as Dietitian, Social Worker and Therapists depending on client need. Family members are included in the process that includes explanation of required procedures, care and discharge planning. Numerous brochures and specific information are available to augment the teaching and education provided. There is a community services directory that outlines the resources available to assist with meeting clients’ ongoing needs.

The consent process is done well and physicians explain and obtain signed consent to invasive procedures. There is discussion of appropriate level of intervention when necessary and this, too, is signed. All disciplines document well and collaborate around care planning. Effort is made to engage family members in learning necessary skills to assist the client. The pharmacist discusses medication needs with clients and families. There is extensive use of clinical practice guidelines, protocols and care maps which are referred to as time lines. Regionalization and program management are cited as having improved interdisciplinary collaboration. Laboratory and radiology staff see themselves as part of the care team.

All professional services state that the new organizational structure encourages working together, including community and home services. This is exemplified in the work done to improve access to the home intravenous therapy program. This is also an excellent example of a quality improvement initiative that considered the results of surveys, statistics and peer review.

The team has identified its priorities for improvement. Some programs are using indicators but generally this is a work in progress. (See Recommendation 5, page 25.) Risks are well managed. The risks associated with cluttered and crowded conditions on the units, particularly in the corridors, require attention. Management will need to find innovative ways for dealing with the situation. As a first step, staff require more fire and safety training. (See Recommendation 3, page 22.)

2. The team is aware of the need to develop a formal discharge planning process to improve continuity of care. Currently, different members of the care team initiate access to the next service thus, the client may experience a gap or lapse in the transition from “in-patient to out-patient”. It is, therefore, recommended that a discharge planning process be developed, implemented and widely communicated to ensure that all clients experience a smooth transition between acute and long term care or home care and support. (See Draft Standards for Comprehensive Health Services 1997, Medical Care, 6, 6.5, 10-10.3.)

This is a broad based team with good internal and external links to clinical programs and community services. Members demonstrate flexibility and a positive attitude to resolving issues as they move forward with integration and co-ordination of care and service within available resources. The process for filling gaps and removing duplication is ongoing.

Although there are multiple access points there are good mechanisms for ensuring an appropriate service level and program to meet client need. The new electronic record is geared to facilitate access to all mental health services and will certainly help to minimize duplication. The move toward common measurement tools will assist with evaluation and ensure consistency in the quality of care and services.

Wait lists are monitored and although each program or service operates separately at the front line, there is integration at the management level. Communication and a willingness to share information is improving as a result of regionalization and freedom of information legislation. There is strong collaboration within program areas and between community connections. Encouragement is offered to increase collaboration with other programs such as neurology, pediatrics, and medicine. Also, links to general practitioners could be strengthened especially around referral information.

Clear boundaries and criteria are in place for each program and service and these are explained to the client. Treatment is negotiated and informational brochures are available to enhance discussion of options. The intake process includes assessment, history, physical and psychiatric assessment. Consent is obtained and families are involved if client is unable to make an informed decision. Clients who are admitted involuntarily are repeatedly informed of their rights as they regain their ability to make decisions. There is also a review procedure and client advocate, both of which are used extensively.

Effort is made to involve the client in care planning and setting of goals. There is an emphasis on informed choice, and recognition is given for the education and counselling provided. If client competency is an issue then an advocate is assigned.

Clinical practice guidelines and literature reviews are used to improve care. A good example of this is the semi-secure room designed to better meet client need. An immediate feedback loop for drug testing of adolescents is another example. There is formal, periodic review of the plan of care, with good links to community services and resources to meet ongoing needs of clients.

Each program and service has a planning day to identify opportunities for improvement and these are brought to the annual planning day for all mental health services. The team is working through the list of priorities for improvement and will prioritize further. The quality improvement plan will be integrated with the overall plan and framework developed for NSHR. Support is given to the plan to use common indicators. (See Recommendation 5, page 25.)

Recognition is given for improving support to chronically mentally ill clients. This was accomplished by reviewing utilization data and developing a program to support these clients. As a result, clients are better supported in the community and their need to access acute care services has significantly decreased.

Consumers perceive a lack of resources which may be tied to expectations of the population served. Regardless, the team is encouraged to review demand for service and processes for assessing priority of client need to ensure that risk is minimized. The team is also encouraged to pursue with primary care services opportunities to increase access.