Canadian National Standards for Emergency Rooms Changed Following WPA Anti-Stigma Survey

Angus H. Thompson

Department of Psychiatry and Alberta Centre for Injury Control &

Research, University of Alberta

Roger C. Bland

Department of Psychiatry University of Alberta

Presented at the first International Congress on Reducing Stigma & Discrimination Because of Schizophrenia, World Psychiatric Association, Leipzig, September 3, 2001.

WPA CAMPAIGN AGAINST THE STIGMA OF SCHIZOPHRENIA: ALBERTA PILOT PROJECT

Local Advisory Committee, Sub-Committee on Health Professions

Julio Arboleda Florez, MD, PhD Chair, Psychiatry Queens University

Laurie Beverly, MN Cont Care Mgr Calgary Health Reg.

Roger Bland, MB Chair, Psychiatry University of Alberta

Ruth Dickson , MD Dir., Psychiatry P. Lougheed Hospital

Beth Evans, BA Pr. Coordinator Alberta MH Board

Marion Ewing, RPN ER Manager Drumheller Health Reg.

Michelle Misurelli Consumer Calgary

Angus Thompson, PhD, Chair Psychologist University of Alberta

Elizabeth Anderson Consumer Calgary

Pilot Site for the WPA Campaign Against the Stigma of Schizophrenia

WPA PilotSites

ALBERTA

METHODS

Phase 1 Methods

1. The Sub-Committee identified Emergency Room (ER) services at general hospitals as a problem for the mentally ill because of attitudes, behaviours and facilities.

Phase 1 Methods

1. The Sub-Committee identified Emergency Room (ER) services at general hospitals as a problem for the mentally ill because of attitudes, behaviours and facilities.

2. The Sub-Committee prepared a questionnaire covering privacy/security, restraints, patient rights, training of staff, patient satisfaction, and planned changes.

Phase 1 Methods

1. The Sub-Committee identified Emergency Room (ER) services at general hospitals as a problem for the mentally ill because of attitudes, behaviours and facilities.

2. The Sub-Committee prepared a questionnaire covering privacy/security, restraints, patient rights, training of staff, patient satisfaction, and planned changes.

3. The questionnaire was completed by the ER program managers in Calgary (3) & Drumheller(1).

World Psychiatric Association Anti-Stigma CampaignEMERGENCY ROOM QUESTIONNAIRE (Item Content)

• Adequacy of interview space (safety, security & privacy).

• Availability of security staff.

• Formal patient rights policy (Existence and provision to patients/family).

• Restraints policy (Existence).

• Availability of specialist (mental health emergencies) staff on-site.

• Adequacy of ER staff training (CME, in-service) in managing mental health crises.

• Evidence for equal access/quality of treatment for the mentally ill (e.g. wait times).

• Adequacy of evaluation of services.

• Plans for any changes in the above areas.

• Additional comments pertaining to the mentally ill in Emergency Departments.

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

•2 had adequate rooms for security & privacy

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

•2 had adequate rooms for security & privacy

•3 had formal patient rights policies, one will provide these to patients/families on request

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

•2 had adequate rooms for security & privacy

•3 had formal patient rights policies, one will provide these to patients/families on request

•3 had specialist MH staff on site for limited hours, with “on call” availability for other times. The rural hospital had difficulty with staffing.

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

•2 had adequate rooms for security & privacy

•3 had formal patient rights policies, one will provide these to patients/families on request

•3 had specialist MH staff on site for limited hours, with “on call” availability for other times. The rural hospital had difficulty with staffing.

•CME for psychiatric emergencies was not required, & the rural hospital had no formal inservice training.

Survey Findings

•3 (of 4 ERs) had adequate access to security staff

•2 had adequate rooms for security & privacy

•3 had formal patient rights policies, one will provide these to patients/families on request

•3 had specialist MH staff on site for limited hours, with “on call” availability for other times. The rural hospital had difficulty with staffing.

•CME for psychiatric emergencies was not required, & the rural hospital had no formal inservice training.

•None had outcome or satisfaction data

Phase 2 Methods

1. A Report of the findings was distributed to the ER Managers and to the Regional Patient Care Manager.

Phase 2 Methods

1. A Report of the findings was distributed to the ER Managers and to the Regional Patient Care Mgr.

2. Discussions were held with the Canadian Council on Health Services Accreditation (CCHSA) -- the national hospital accreditation body.

Phase 2 Methods

1. A Report of the findings was distributed to the ER Managers and to the Regional Patient Care Mgr.

2. Discussions were held with the Canadian Council on Health Services Accreditation (CCHSA) -- the national hospital accreditation body.

3. The Sub-Committee, upon invitation, proposed changes to the CCHSA accreditation protocol.

PROPOSED ER GUIDELINES FOR

PATIENTS WITH A MENTAL ILLNESS

PROPOSED ER GUIDELINESGeneral Headings

P1.0 The examination and interview process and space are adequate for the safety, security, and privacy of patients and staff

PROPOSED ER GUIDELINESGeneral Headings

P1.0 The examination and interview process and space are adequate for the safety, security, and privacy of patients and staff

P2.0 There is a client/pt. /family rights policy that defines its application to mentally ill individuals

PROPOSED ER GUIDELINESGeneral Headings

P1.0 The examination and interview process and space are adequate for the safety, security, and privacy of patients and staff

P2.0 There is a client/pt. /family rights policy that defines its application to mentally ill individuals

P3.0 Staff will be available who have competence in the management of mental health emergencies

PROPOSED ER GUIDELINESGeneral Headings

P1.0 The examination and interview process and space are adequate for the safety, security, and privacy of patients and staff

P2.0 There is a client/pt. /family rights policy that defines its application to mentally ill individuals

P3.0 Staff will be available who have competence in the management of mental health emergencies

P4.0 The quality of services to psychiatric patients will be evaluated

CONSEQUENCES

Consequences

1. The Report led some ERs to seek funding to remedy individual deficiencies, and there was an expressed wish to have more clearly defined standards.

Consequences

1. The Report led some ERs to seek funding to remedy individual deficiencies, and there was an expressed wish to have more clearly defined standards.

2. The report was used by the hospitals for their local reviews and in preparation for the next round of accreditation surveys by the CCHSA.

Consequences

1. The Report led some ERs to seek funding to remedy individual deficiencies, and there was an expressed wish to have more clearly defined standards.

2. The report was used by the hospitals for their local reviews and in preparation for the next round of accreditation surveys by the CCHSA.

3. The CCHSA considered the Sub-Committee recommendations (& those from other sources).

• All but one were completely adopted• The exception (a private interview room)

was partially endorsed.

DISCUSSION

Discussion

Consumer input can lead to a change in national hospital service standards, dependent on:

Discussion

Consumer input can lead to a change in national hospital service standards, dependent on:

1. Consumer identification of a valid issue

Discussion

Consumer input can lead to a change in national hospital service standards, dependent on:

1. Consumer identification of a valid issue

2. A "win-win" relationship with the hospitals

Discussion

Consumer input can lead to a change in national hospital service standards, dependent on:

1. Consumer identification of a valid issue

2. A "win-win" relationship with the hospitals

3. Early collaboration with our national accreditation body

Discussion

Consumer input can lead to a change in national hospital service standards, dependent on:

1. Consumer identification of a valid issue

2. A "win-win" relationship with the hospitals

3. Early collaboration with our national accreditation body

4. Luck!

ACKNOWLEDGEMENTS

Judith McLeay ER Manager Foothills Hospital

Donna Kelly ER Manager Peter Lougheed Centre

Lois Reister ER Manager Rockyview Gen. Hospital

Beth Dorsey Regional Pt Calgary Regional HealthCare Mgr AuthorityPsych Emerg

Paula Greco Canadian Council on Health Services Accreditation www.cchsa.ca

FIN

World Psychiatric Association Anti-Stigma CampaignEMERGENCY ROOM QUESTIONNAIRE

The World Psychiatric Association is leading an international health campaign to reduce the stigma associated with schizophrenia. Calgary and Drumheller were chosen by an international committee to be a pilot site for the implementation of this campaign, which includes the development of materials for use in other jurisdictions worldwide. One of the areas identified was emergency room services. The goal for this part of the campaign is that persons with schizophrenia and other mental illnesses will be viewed as being as important as those with physical illness. We would appreciate your help in reviewing Emergency Room service in your region by providing the following information for your Emergency Department.•.Is adequate, safe, secure space, ensuring reasonable privacy, available for the examination and interview of psychiatric patients and their families?•.Is security staff available? •.Is there a written statement of patient rights in your hospital? If so, how and when is it provided to psychiatric patients who present at the ER?•.If restraints are used, is there a policy in place? (Please provide copies, if available).•.Do you provide on-site staff who are trained in managing mental health emergencies? If yes (circle one):

At all times At specified hours only On call only A combination of the above (please provide details)

•.Are your Emergency Room medical staff trained in managing mental health crises? Are they required to participate in CME in this area? How does this compare with requirements, training, and qualification in other areas of medicine?

•.Are your other staff (e.g. nurses) trained in managing mental health emergencies? If trained, how did they receive the training? Is there any in-service requirement in this field?

•.If you have data on whether wait times differ in any way from those with other illnesses or conditions, please provide the most recent results.•.If you have data on patient (mental health) and family satisfaction with your Emergency Room services, please provide a copy of the most recent results. Please include data, if possible, drawn from patients with other illnesses. Is such data collected on a regular basis?•.Do you have plans for any changes in the above areas?•.Do you have any comments pertaining to the care of the mentally ill in Emergency Departments?

PROPOSED ER GUIDELINES FOR

PATIENTS WITH A MENTAL ILLNESS

Detailed Recommendations

ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS

P1.0 The examination and interview process and space are adequate for the safety, security, and privacy of patients and staff

P1.1 There are enough private interview rooms available to ensure privacy during interviews in most situations

P1.2 Interview rooms are secureP1.3 Security staff are available on a timely, as

needed, basisP1.4 There is a policy in place governing the use of

restraints

ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS

P2.0 There is a client/pt. /family rights policy that defines its application to mentally ill individuals

P2.1 Information on rights is provided to the patientP2.2 These rights are provided in a timely mannerP2.3 There is a policy whereby an interested second

party is consulted when the patient’s mental illness interferes with the understanding of these rights

P2.4 There is a process for obtaining consent on behalf of a patient when mental illness interferes with understanding of the intervention being offered

P2.5 There is a process for deferring the above provisions in emergent cases

P2.6 There is a process for patients & families to voice concerns about rights violations

ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS

P3.0 Staff will be available who have competence in the management of mental health emergencies

P3.1 Staff will be available who are qualified to manage mental health emergencies

P3.2 In-service training is provided to fill any gaps in staff skills

P3.3 Staff will have acquired a “sensitivity” to mental illness

ER GUIDELINES: PATIENTS WITH A MENTAL ILLNESS

P4.0 The quality of services to psychiatric patients will be evaluated

P4.1 There is information on whether wait times for psychiatric patients differ from those with other illnesses or conditions

P4.2 Information on patient and family service satisfaction is gathered

P4.3 Information is gathered on the quality of treatment provided to ER psychiatric patients