John Muir Health Behavioral Health Services Psychiatric Assessment and Liaison Services October 2, 2006

1. John Muir HealthBehavioral Health ServicesPsychiatric Assessment and Liaison ServicesOctober 2, 2006

2. John Muir Health Community Hospital 200 beds Trauma Center 320 beds Physician Network 700 physicians Acute Psychiatric Hospital 73 beds (child, adolescent and adult, Behavioral Health & Adult Chemical Dependency and outpatient services)

3. Overview of Services Psychiatric Assessment Services RN�s respond to ED�s within 1 hour of call Admit to Behavioral Health Hospital or transfer to other dispositions Inpatient Psychiatric Consultation Psychiatrists available daily to consult on medical patients with psychiatric/CD issues Liaison Nurse Service RN Clinical Specialist/Advanced Practice Nurse available for inpatient consultation to develop behavioral treatment plans with other clinicians Inpatient Chemical Dependency Assessment & Consultation CD staff available to meet with inpatients regarding follow-up CD issues ASAM Certified Addictionologist Provides consultation for Inpatients and ICU�s regarding detox protocols and chemical dependency complications Staff Training for Crisis intervention Emergency Department staff were trained in Crisis Prevention and Intervention (CPI). Certified trainers are now available to conduct regular trainings of ED staff

4. Benefits Emergency Department Throughput Reduce LOS for Inpatient med-surg patients with behavioral health co-morbidities Decrease Staff Injuries and Anxiety Improve Patient Care Improve Patient Experience Increase Patient Safety Reduce Negative Outcomes (DT�s, suicide attempts, agitation, etc.) Reduce liability regarding involuntary holds and the application of such Ensure consistent care for high risk patients

5. Financial Arrangements Acute hospitals contract with Behavioral Health for the provision of Psychiatric Assessment and Liaison services Behavioral Health then contracts with independent psychiatrists for the provision of consultation services Behavioral health provides the nursing staff for assessment services

6. Opportunities for Collaboration For Health Systems that do not have a behavioral health service or hospital, consider partnering with other hospitals or health systems for the components of a Psychiatric Assessment and liaison service. Collaboration with your county is also important. Hospital and county leaders should work together to ensure that psychiatric patients have access to community resources and care. As an example, hospitals, physicians and county health leaders formed a task force in our county to address the issue of involuntary holds and appropriate procedures to place patients on involuntary holds in our emergency departments throughout the county. Criteria were clarified, procedures were revised and a training program and video were developed to ensure consistent application of involuntary hold policies and procedures.