Implementation of Early Psychosis Intervention Program ... - EENet

58Table 19: Working with inpatient units: Implementation by program typeSurvey Question Response All Large Small Hospital CommunitySitesQ94: How often able to% sites implementing 71 77 62 83 52implement this element‘most of the time’Large: catchment area population > 100,000 population (31 program sites)Small: catchment area population < 100,000 population (21 program sites)Hospital: hospital is parent organization (30 program sites)Community: community agency is parent organization (22 program sites).Main challenges to working with inpatient units noted by programs:o Psychiatric care difficulties. For instance, confusion over which psychiatrist (inpatient or EPI)provides care; differences between EPI and inpatient psychiatrist approaches to illnessmanagement (e.g., some psychiatrists do not support EPI, changing client’s medications).o Staff attitudes in inpatient unit or emergency department and their understanding ofcommunity support programs.o Client negative responses to hospitalization (e.g., minimizing symptoms to shorten admission,instability)o Poor communication between inpatient unit and EPI program, for example, EPI program staffnot allowed to view documentation of admitted clients, not notified that client has beenadmitted until after discharge or no protocol for communication.o EPI program not involved in discharge planning from inpatient unit and client not prepared orwell enough to be discharged.o EPI program resource limitations for visiting inpatient units, which include staff time,geography and travel.o Access when inpatient unit is in distant location.Strategies suggested by programs for working with inpatient units:o Conduct proactive outreach to build rapport with hospital team, educate about the EPIprogram and establish processes and communication strategies for client management.o At EPI client program admission, obtain client/family consent to communicate relevantinformation with inpatient unit if needed.o Participate in unit rounds, care planning meetings and discharge planning; visit clientsthroughout their admission.o If a discharge referral is received, visit client on the unit and assess suitability for program.o These collaborations may require authorizations and formal protocols between hospital unitand EPI program.o Hospital sponsored EPI programs reported some home organization benefits – e.g.,notification if EPI client is admitted to their hospital, access to unit charts for EPI clients andother documentation, communication between EPI program and inpatient physicians.What would help programs for working with inpatient units:o Improved communication between EPI programs and inpatient units, at time of admission,during treatment in inpatient unit and at time of discharge planningo Access to electronic charts or inpatient program notes – may require policy change.