Seattle Childrens Hospital Parent Initiated Treatment from an
Seattle Childrens Hospital Parent Initiated Treatment from an Inpatient Psychiatric Hospital Perspective Presented by: Kathy Brewer, MS, LMHC, Manager, Utilization Review Date: May 21, 2018 Readmissions: Our inpatient unit has an overall 10% rate of readmission within 30 days of discharge (data from September 2017). class and commercial Readmission < 30 days Totalabout Admissionsthe Readmission Rate Payer BHO
plans same. Commercial 129 1347 10% Financial Aid Medicaid Other Tricare Medicaid-BHO-ITA Medicaid-BHO Grand Total 0 1 0 13 12 83 238
2 16 1 90 44 935 2435 0% 6% 0% 14% 27% 9% 10% Payer Based Variation: Average LOS for all Commercial Average of # of days admission data from September 2017
Average of # of days admission (LOS) 7.1 Average LOS for all BHOs 6.4 Grays Harbor BHO 12.0 Greater Columbia BHO 11.1 Salish BHO 10.3 North Central BHO
Lewis County BHO 7.0 Optum Pierce BHO 7.0 North Sound BHO 5.9 King County BHO 5.8 - 2.0 4.0
6.0 8.0 10.0 12.0 14.0 PIT Volume: From 7/13 to 6/17, 66% of admissions were voluntary, 29% were PIT, and 5% were ITA. Admits by type, year 800 700 600 Voluntary PIT ITA
500 400 300 200 100 0 YEAR Jul 13 - Jun 14 Jul 14 - Jun 15 Jul 15 - Jun 16 Jul 16 - Jun 17 PIT Notification Process: All parents/guardians of patients ages 13-17 are provided a copy of the Mental Health Treatment Options for Minors in the emergency department, whether or not their child is admitted. Patients admitted under PIT are provided a copy of When Your Parent Admits You to the Inpatient Psychiatry and Behavioral Medicine Unit which describes their rights.
PIT Advantages: Patients are motivated to stabilize in order to discharge. Parents feel empowered to help their child obtain necessary treatment. PIT admissions are less traumatic for teens compared to having to go to ITA court (strapped to a gurney). PIT admissions allow providers to spend their time delivering needed care in the hospital instead of testifying in court and waiting PIT Barriers: PIT is not an option if there is no parent or legal guardian available to give consent must have legal guardian or Childrens Administration case worker consent if patient is in dependency Other caregiving relatives and foster parents are not allowed to give consent for PIT admission. PIT less effective if parents disagree with the
treatment plan or worry about teen anger directed at them re: admission PIT Barriers: PIT does not allow providers to compel medications; patients must consent If compelling antipsychotic medications is necessary, this is a reason to convert to ITA There is no less restrictive order (LRO) for PIT The LRO can serve as a safety net which allows a patient to be readmitted for evaluation by DMHP if the patient is not following the agreement that led to discharge and/or becoming unsafe again. Without ITAs LRO, only outpatient option to compel treatment is parent submitting an At-Risk-Youth petition to juvenile court PIT Barriers: Community providers prefer ITA if concerned patient may need CLIP facility
patients on 180 day orders are eligible for CLIP Voluntary CLIP process burdensome - very time consuming in some counties PIT expires 30 days after review, regardless of patient stability. If a patient cannot be safely discharge, an ITA evaluation will be need to be pursued to keep the patient in the hospital. PIT Barriers: Authorization from payer is required for PIT admission and continued stay. Challenge to help families ready to take their child home when safe, but still symptomatic Length of authorizations has been decreasing Youth with developmental disabilities stabilizing on unit at time of PIT review but still not safe to return home We have had several patients denied for continued stay under PIT and had to request ITA to continue a stay due to safety concerns
PIT Dynamics: Inpatient Significant regional differences in PIT referrals King and other urban counties often refer patients under PIT Many rural counties seem to avoid PIT Our clinical teams will then drop the rural ITA and convert to PIT soon after admission after talking with parents/legal guardians ITA request means Designated Crisis Responder (DCR) does an ER evaluation, which a rural hospital might rely on for getting a psychiatric assessment PIT Dynamics: Outpatient We have a large outpatient program. We have not used outpatient PIT primarily because evaluation only is not particularly helpful to families. Treatment is the most helpful mental health intervention, and the outpatient PIT law only includes evaluation.
There is general lack of awareness about outpatient PIT options and not the same notification requirements for providers. Recommendations: Funding to increase consistent education about PIT across Washington State for: BHO contracted agencies DCR Emergency department personnel Hospitals Medicaid funds for intermediate levels of care such as partial hospitalization, intensive outpatient, residential treatment (e.g. severe eating disorders not well served by CLIP). Recommendations: Consider changing the law to allow for PIT stays longer than 30 days to remove need to convert some to ITA OR consider revision to change ITA law for juveniles to count
time already under PIT for PIT to ITA conversions Clarify areas in the law regarding consent to release information for patients admitted under PIT (i.e. who has authority to release records) Considering changing the law regarding outpatient PIT to include treatment (maybe with time limits?) and expectations to notify parents about outpatient PIT as an option
Oracle Corporation Founded in 1977 $13 billion company Employees 48,000+ Annual R&D over $1 Billion Oracle: the Information Company Practical Example Just about every online transaction touches Oracle software.
"to the victor belong the spoils" replaces the qualified with those who vote well… 5/13 south carolina refuses to collect "tariff of abominations" threatens to secede… jackson prepares to send in the military clay and congress work out compromise…
Time inconsistency is the tendency to systematically misjudge at the present time what you will want to do at some future time. It is as if your future self ends up disagreeing with your present self. This is a major...
con together conjunction confidence com together combination combo extra beyond extraterrestrial extrovert non not nonstop intra within intranet intravenous inter between interlopers international semi half semicircle post after postscript posthumous super over supervise mis bad misfit mistake tri three tricycle...
regions and branches ACA has 56 branches, including each state, plus the District of Columbia, Europe, Latin America, Puerto Rico, Virgin Islands and the Philippines. The branches are organized into four regions: ACA Midwest Region, ACA North Atlantic Region, ACA...
Sales Education and Performance Consulting Presents Using the Automated Order Workbook July 2005 Automated Order Workbook Course Elements AOW Overview Getting Started General Account Information (GAI) Product & Term Master Agreement Order Type Features Managing Orders for Multiple Locations Billing...
in the past people did take a lot of care with data and metadata but it came to nothing; we need to have high requirements for long term preservation for it to be useful Session 3: Physical Sciences & Engineering...
DNN-Based Prediction Model for Spatial-Temporal Data. ACM SIGSPAITAL 2016 . Four different flows are defined. in-flow, the total traffic of crowds entering a region from other places during a given time interval;
Ready to download the document? Go ahead and hit continue!