Pit Appointments: A new collaborative Psychiatric...

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Pit Appointments:A new collaborative Psychiatric Assessment

A Race Against TimeDr. Marilyn Thorpe, Psychiatrist

Our Family Doctors in 2013

122Mental health patients per week

= average 17 per day

Our Family Doctors in 2013

Average 43 day wait for psychiatry

(up to 272)

Dissatisfied100%

122Mental health patients per week

= average 17 per day

And the Psychiatrist Survey Says…

• March 2015, 50% of psychiatric consultations could have been treated with less time

• April, 40 patients on the waiting list

• Team reviewed and allotted 36/40 for “pit spots”

• May 14, 2015 began four 30

minute spots 3 days a week

• Proved successful

Pit Assessments at UVic

PIT Project - Specialist Services Committee

Pit Assessments Reduced Wait Times to See a Psychiatrist

Before Pit

Pit Starts

Wait Times for Psychiatric Consultations Also Fell After Pit Assessments

Pit Starts

Psychiatry Wait Times Significantly Reduced

231512 11 10

1015202530354045

2013 2014 2015 2016

Consultations

Pit Assessments

* transition year

What is a Pit Assessment?

Making a Referral

• Filling out the form

• What is the Family Doctor looking for?

• What is the patient looking for?

• Option: doing it with the patient

Briefing

Family Doctor describes patient history and current problem

The Pit

Briefing

The Pit

Introduction Goals Interview

Closing

5 250 30

ClosingThe PitBriefing

Family Doctor organizes treatment plan and prescribes as necessary

Psychiatrist documents

A Pit Assessment

Essential Factors for a Successful Pit

Rapport

1. An established relationship between the family doctor

and the patient (mandatory)

Team Mentality

2. A collaborative, respectful atmosphere

Clear Expectations

3. Referral Form & Patient Information Sheet

Punctuality

4. Start on time (changed times)

Communicate About Next Steps

4. Start on time (changed times)

5. End with a definitive plan (contingency)

Benefits From a Family Doctor’s Perspective

• Interviews with family doctors revealed pit

assessments:

• Improve their competence

• Improve their confidence

• Teach them about• Medications and treatment options

• How to decipher coping and complicating personality factors

Benefits From a Psychiatrist’s Perspective

• Less paperwork for psychiatrists

• 50% less psychiatry cost than traditional consultations

• Increased team work and support in crisis

• Satisfaction knowing patients will be followed well

• Intense and use high clinical acumen

Patient’s Perspective

• Trust in the family doctor

• Comfort of the doctor and room

• Not having to repeat their story

• Having rapid access to a psychiatrist

Because I was in a crisis … [I had a pit] instead of waiting for [a] consultation. I'm glad that they realized how important it was for me to start seeing someone immediately.

Having the doctor with me as an advocate was very helpful. I find being alone with psychiatrists very difficult.

I got in very quickly, the [psychiatrist] already had an understanding of my history as given to her by my doctor,and we were able to focus on what was the issue at the present time.

Most Students Preferred the Shorter Wait

0 5 10 15 20

Would have preferred a longer wait for a full consultation

Preferred shorter wait for a pit assessment

Number of StudentsN = 23

13% 45% 42%

-5 5 15 25 35

Number of StudentsN = 38

Not Helpul Mildly Helpful Very Helpful

Pit Assessments

Most Students Find Pit Assessments Helpful

Who is Suitable for Pit Assessment?

• Medication question

• Consult wanted (by community or patient) but not indicated

• Question of complicating personality disorder

• Differentiating bipolar disorder from personality disorder

• Verification of present treatment

• Triage for psychotherapy

Either Pit Assessment or Consultation

• Recommendations for crisis management

• Recommendations with potential medical-legal worries

• Questioning Autistic Spectrum Disorder (patient

tolerance specific)

Better Suited for a Psychiatric Consultation

• Psychosis

• Management of complicated affective disorder

• Patient with multiple acute priorities and a long

complicated history

Suitable for Reason for Referral

Pit Assessment • Medication question• Consult wanted (by community or patient) but not indicated• Triage for psychotherapy• Is this case being complicated by a personality disorder• Differentiating bipolar disorder from personality disorder• Am I on the right track with my treatment?

Psychiatric Consultation

• Psychosis• Management of complicated affective disorder• Patient with long complicated history and I do not know

where to start

Either type • Recommendations for crisis management• Recommendations with potential medical-legal worries• Is this Autistic Spectrum Disorder? (patient tolerance

specific)

Let us show you

If implemented at your organization, pit assessments could:

Decrease wait times to see a psychiatrist

Reduce the number psychiatric consultations necessary, and decrease wait times for them

Decrease emergency room visits

Help patients get well faster

Improve knowledge of family doctors

Help students succeed academically and live well

Work smarter, not harder

The Pitfalls and Buy In

A Pit Assessment

The Buy In

http://webarchive.nationalarchi

ves.gov.uk/20150401220127/

http://www.institute.nhs.uk/ind

ex.php?option=com_spread_

and_adoption

Spread

Other universities?

General community Family Practice?

Funding

family doctors

two physicians billing simultaneously

travel time

Suggestion for Ontario:

thanks to Denise Belanger, U Ottawa at CACUSS:

We made part of our health services a “Family Health

Team” which gives us sessional “fit funding” to pay for

psychiatry.

Project Team (Pit Crew) Members

Funding for this initiative was provided for by the Specialist Services Committee (SSC), one of four joint collaborative committees representing a partnership of Doctors of BC and the BC Ministry of Health.

SECONDARYDr. Andre Kushniruk – Co-InvestigatorDr. Elizabeth Borycki – Co-InvestigatorDr. Judy Burgess – Clinic DirectorDr. Leigh Greiner – Data Analyst

COREDr. Marilyn Thorpe – Project LeadHelen Monkman – Project ManagerDr. Oona Hayes – GP Mental Health LeadDr. James Felix – GP Mental Health LeadTheresa Brown – MOA for Mental Health Geraldine Kiss – MOA for Family Doctors

FAMILY DOCTORSDr. S. Baskerville-Bridges Dr. J. Bowles Dr. M. Brydon Dr. W. DysonDr. B. Fraser Dr. K. Foster Dr. J. FryDr. C. Gray Dr. T. GarnettDr. J. KimDr. C. LeviaDr. S. MartinDr. B. Meeker Dr. S. StewartDr. L .Warder

PSYCHIATRISTSDr. E. BurrellDr. M. CooperDr. J. CheekDr. C. DuncalfDr. M. Ganzer (Resident) Dr. I. LorinczDr. P. Singh (Resident)

MH NURSECathy Buchan

Special thank you to:

• Natalia Jaworska (U Calgary, McGill U)

• Elisea De Somma (U Calgary, York U)

• Bernice Fonseka (U Calgary)

• Emma Heck ((U Calgary, Queens U)

• Glenda MacQueen (U Calgary)

Mental Health Services for Students at Postsecondary Institutions: A

National Survey, Can J Psychiatry. 2016. 61(12): 766-775

Contact Information

pitproject.psychiatry@gmail.com

pitproject.ca

Thank you!

Questions and Suggestions?

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