Implementing an emergency department protocol to improve the quality of care and patient experience for children and youth with mental health emergencies

This award will help establish a standardized approach to acute care for mental health crises at BC Children’s Hospital’s Emergency Department (BCCH ED). BCCH is the only quaternary level PED in BC and receives over 46,000 annual visits, of which almost 1,000 are mental health related. Over an 11-year period, the annual number of mental health visits at BCCH increased by 86 percent, from 529 visits in 2002 to 983 in 2012. Youth with mental health concerns are among the fastest growing segment of the ED population and this is true across North America. Data further shows that repeat visits account for almost one-third of all mental health visits, suggesting a need for improvement in the discharge and follow up processes.

This project will implement a child and youth specific ED protocol for the clinical assessment, management and discharge of patients with mental health concerns at BCCH ED. Supported by a partnership between the Doctors of BC and the BC Ministry of Health (Shared Care), the Child & Youth Mental Health & Substance Use Emergency Department Protocol (CYMHSU ED protocol), which includes HEARTSMAP, a validated clinical assessment tool, is already being implemented in community EDs across BC. Unfortunately, the BCCH ED was not included in the provincial plans and has not benefited from this initiative. This omission may cause non-uniform use of the HEARTSMAP tool and discrepancies in care, discharge planning, and referral/follow up plans for youth seen at BCCH ED compared to the rest of BC.

Scientific evidence will be used to:

1. Improve youth and family care by orienting them to the BC mental healthcare system, including information about the role of the emergency department and access to community mental health resources after discharge.
2. Help PED clinicians conduct efficient and effective emergency psychosocial assessments with proper documentation, and guide them in choosing the right mental health service at the right time to optimize patient care.
3. Evaluate the effectiveness of this implementation program.

To reach these aims, three activities are proposed:

1. Customize the CYMHSU ED protocol components for use at BCCH ED.
2. Implement the protocol through workshops for clinical end-users.
3. Evaluate the effectiveness of the implementation program.