Bridging the Acute-to-Outpatient Care Gap in Mental Health: Developing and Implementing a Mental Health Transition Process.

BACKGROUND: A national Department of Veterans Affairs (VA) mental health (MH) quality metric tracks engagement in outpatient MH care after discharge from residential and inpatient settings, with recommendations for 2 or more visits 30 days postdischarge. LOCAL PROBLEM: A gap in transitioning patients from residential to outpatient MH care was identified at this site. METHODS: A transition management process was developed and piloted, including a new MH Discharge Consult and an RN Transition Care Managers team. INTERVENTIONS: Transition Care Managers triaged Discharge Consults, communicated with schedulers and patients pre- and postdischarge, and tracked MH engagement for 30 days postdischarge. Process, outcome, and balancing measures were developed and iteratively adjusted using Plan-Do-Study-Act (PDSA) cycles. RESULTS: Over 55 weeks, 443 Discharge Consults were placed. There was an average 89% success rate in connecting patients with 2 or more MH visits versus 53% preintervention. CONCLUSIONS: This pilot showed promising results in improving postdischarge MH engagement with the use of PDSA cycles to collect data and refine processes.

Implementation of the standardized, evidence-based three-stage suicide risk screening: Experience of a large Veterans Affairs medical center.

ABSTRACT: Suicide is a global public health concern and may be preventable with early identification. The suicide rate among US veterans is increasing. In response to the increase, Veterans Health Administration recommended a new standardized three-step, evidence-based suicide risk screening process across all Veterans Health Administration sites. The purpose of this project was to implement the new three-step suicide screening method and evaluate the rate of provider adherence. The implementation occurred in seven clinical sites in the Veterans Affairs Greater Los Angeles Health care System. Following initial implementation, two Plan-Do-Study-Act (PDSA) evaluated provider adherence to the screening processes. Staff members at each site received suicide prevention education. Staff members had the option of using an embedded template in the course of normal patient care workflow. Plan-Do-Study-Act 1 measured the early results. Staff members achieved a performance adherence rate of 18%, indicating that staff were less likely to proactively screen for risk of suicide. In PDSA-2, the mandatory use of screening replaced the optional use. Staff members achieved a 95% adherence rate after 3 months. Changing the workflow within the electronic health record from optional to mandatory utilization brought forth improvements in suicide prevention screening.