Patient referrals to the new Day Hospital at Alberta Hospital Edmonton (AHE) are on a slow-but-steady upswing, two months after this first-of-its-kind treatment facility in Edmonton opened its doors.
"We opened the Day Hospital on Jan. 7th. It has been a gradual, staged opening but over the last three or four weeks we've been getting steadily busier," says AHE Medical Director Dr. P.J. (Patrick) White.
"What we're seeing is a significant effect on volumes among EIPs (Emergency Inpatients) and the local ERs (Emergency Rooms), so there has been a lot of positive satisfaction coming back from the ER physicians."
The Day Hospital - formally known as the Addictions and Mental Health Edmonton Day Hospital - offers group and individualized daytime programming for acutely ill patients, seven days a week, as an alternative to full hospitalization. Patients go home each evening and return the following morning, with transportation provided as needed.
"This is an acute facility, so all of our patients are acutely mentally ill or unstable. But the average length of stay in the day program is just three weeks. Then patients move on to the community or to outpatient care or various psychotherapy groups. The reason for that is the program needs to be a moving beast, so to speak, so our patients keep flowing through. We don't want it getting blocked," explains Dr. White.
Comprehensive patient data for the first two months of operation isn't yet available. But Dr. White did offer an initial snapshot. During the first two weeks of operation, he says, a total of 73 patients were referred to the Day Hospital, located on the ground floor of 12 building on the AHE campus.
A little over half (53%) of those patients were referred by local Hospital Inpatient Units, 30% were referred by Emergency Departments, and 17% came from the community. About 71% of all referrals were accepted.
Key reasons why patients were referred to the Day Hospital include: mood and anxiety stabilization; emotional dysregulation (including high ER use); medication management / adjustment and treatment for Psychosis (reflecting decreased length-of-stay in Inpatient Units); addictions identification, stabilization and management; and need for urgent access to the Day Hospital's two rTMS machines.
The rTMS (Repetitive Transcranial Magnetic Stimulation) machines provide an effective, less invasive option for treating major depression than traditional ECT (Electroconvulsive therapy) treatments.
Although Ponoka's Centennial Centre for Mental Health and Brain Injury has had an rTMS machine for some time, the Day Hospital units are the first two publicly funded rTMS devices in Alberta Health Services' (AHS's) Edmonton Zone. Psychiatrists Dr. Kevin Morin and Dr. Karthikeyan Ganapathy are overseeing the rTMS treatments.
"The Day Hospital fills a very important gap. We have acute Inpatient Units and we have Community Clinics. Some people may be so unwell they can't make it to scheduled appointments, yet they need to be seen every day. Until now we've had no alternative but to admit those people to an Inpatient Unit," says Mark Snaterse, Executive Director for Addiction and Mental Health, Alberta Health Services (AHS), Edmonton Zone.
"But these patients may have a supportive family and a home where they can sleep in at night. So instead of occupying an acute bed 24/7, we can refer them to the Day Hospital, where they'll get all the intensive acute interventions they need, but still go home at night and sleep in their own bed."
Dr. White, a former Alberta Medical Association (AMA) President, Past President of the Canadian Psychiatry Association (CPA) and previous Chair of the University of Alberta's Department of Psychiatry, says he is pleased with the early results from the Day Hospital.
"The Day Hospital seems to be functioning exactly the way we wanted it to. We're catering to people who are acutely mentally ill but who are not at risk, and we're also dealing with patients who are transitioning from Inpatient Care into the community," he says.
"We've also had a number of patients who have had to be certified and sent to hospital. That's where the risk assessment process (for suicide or potential self-harm) is so important. Each patient is seen by a psychiatrist at the time of referral, and we do a formal risk assessment then. I've been involved in two cases where we had to send patients back to hospital."
To meet the expected growth in demand for services, AHE has offered positions to a number of physicians at the Day Hospital. One is expected to start in early March, and two others are likely to begin working on a half-time basis in April, says Dr. White.
Like similar facilities in Calgary and Vancouver, the Day Hospital will ultimately be staffed by a full multi-disciplinary team including psychiatrists, psychologists, social workers, occupational therapists and others, with an emphasis on rapid patient transition back to the community.
The Day Hospital is the first of several major initiatives being launched by AHE as part of its Ambition 2023 project. It was unveiled last year, in response to a challenge from Dr. Verna Yiu, AHS's President and CEO, to make AHE more relevant and responsive to individuals and families in the Edmonton Zone who are grappling with complex addictions and mental health challenges.
"Our core strength at Alberta Hospital Edmonton is dealing with the chronically mentally ill, but Ambition 2023 is widening the template here, into the Zone and the broader community. It's an Edmonton-based Zone initiative," says Dr. White.
"The initial vision with Ambition 2023 was to have two Day Hospitals, one here at Alberta Hospital and the other in the city. Funding was only available for one at present, but additional funding may be available if the Day Hospital makes clinical and economic sense."
Ambition 2023 is built around five "pillars" or key priorities. In addition to the Day Hospital, they include:
• Neuropsychiatry & Neuropsychology: Under the Edmonton Neuro-Cognitive Disorders Enterprise (ENCoDE), clinicians aim to address a major gap in diagnostic, treatment and monitoring services for people whose psychiatric disorders are linked to cerebral pathology.
• Redefining Tertiary Care in Psychiatry: Physicians and staff in Tertiary Care are working to realign rehabilitation treatment, programming and clinical processes to better meet the needs of those with intellectual disabilities and/or mental health issues.
• Young Adults: AHE has a unique acute care unit for patients aged 16 to 26, complementing various community-based young adult services. Inpatient enhancements at AHE are planned.
• Targeting Treatment-Resistant Psychosis: AHS Addiction and Mental Health and the Department of Psychiatry are working jointly on an evidence-based holistic treatment for treatment-resistant psychosis.
"What we will be doing in the very near future is a research project where we will be looking at all the data that is now being collected from a systemic perspective to see what effect the Day Hospital is having, not only clinically but statistically, so we get a clearer picture of the difference it is making on demand for Inpatient beds. But the initial anecdotal evidence is that it's already having a very positive effect."
Dr. Melanie Marsh-Joyal, President of the Alberta Psychiatric Association and Emergency & Consultation Liaison Psychiatrist at the Royal Alexandra Hospital, welcomes the new Day Hospital and applauds the collaborative approach taken by team leads Mike Mach and Dr. Daniel Li in bringing it to life.
"What we have appreciated about Dr. Li and Mike is the value they have clearly placed on the importance of collaboration between our teams. They have been actively seeking our feedback and looking for ways to enhance process and ultimately enhance our ability to provide safe, evidence-based, seamless patient care," says Dr. Marsh-Joyal, who also serves as an Assistant Clinical Professor in the Department of Psychiatry.
Nonetheless, she says it's too early to know with certainty if the Day Hospital will ease demand for Emergency Psychiatric Services in the Edmonton Zone. "We will have a much better sense of the impact on our Emergency Departments after a solid eight to 12 months of the Day Hospital being operational."
"We opened the Day Hospital on Jan. 7th. It has been a gradual, staged opening but over the last three or four weeks we've been getting steadily busier," says AHE Medical Director Dr. P.J. (Patrick) White.
"What we're seeing is a significant effect on volumes among EIPs (Emergency Inpatients) and the local ERs (Emergency Rooms), so there has been a lot of positive satisfaction coming back from the ER physicians."
The Day Hospital - formally known as the Addictions and Mental Health Edmonton Day Hospital - offers group and individualized daytime programming for acutely ill patients, seven days a week, as an alternative to full hospitalization. Patients go home each evening and return the following morning, with transportation provided as needed.
"This is an acute facility, so all of our patients are acutely mentally ill or unstable. But the average length of stay in the day program is just three weeks. Then patients move on to the community or to outpatient care or various psychotherapy groups. The reason for that is the program needs to be a moving beast, so to speak, so our patients keep flowing through. We don't want it getting blocked," explains Dr. White.
Comprehensive patient data for the first two months of operation isn't yet available. But Dr. White did offer an initial snapshot. During the first two weeks of operation, he says, a total of 73 patients were referred to the Day Hospital, located on the ground floor of 12 building on the AHE campus.
A little over half (53%) of those patients were referred by local Hospital Inpatient Units, 30% were referred by Emergency Departments, and 17% came from the community. About 71% of all referrals were accepted.
Key reasons why patients were referred to the Day Hospital include: mood and anxiety stabilization; emotional dysregulation (including high ER use); medication management / adjustment and treatment for Psychosis (reflecting decreased length-of-stay in Inpatient Units); addictions identification, stabilization and management; and need for urgent access to the Day Hospital's two rTMS machines.
The rTMS (Repetitive Transcranial Magnetic Stimulation) machines provide an effective, less invasive option for treating major depression than traditional ECT (Electroconvulsive therapy) treatments.
Although Ponoka's Centennial Centre for Mental Health and Brain Injury has had an rTMS machine for some time, the Day Hospital units are the first two publicly funded rTMS devices in Alberta Health Services' (AHS's) Edmonton Zone. Psychiatrists Dr. Kevin Morin and Dr. Karthikeyan Ganapathy are overseeing the rTMS treatments.
"The Day Hospital fills a very important gap. We have acute Inpatient Units and we have Community Clinics. Some people may be so unwell they can't make it to scheduled appointments, yet they need to be seen every day. Until now we've had no alternative but to admit those people to an Inpatient Unit," says Mark Snaterse, Executive Director for Addiction and Mental Health, Alberta Health Services (AHS), Edmonton Zone.
"But these patients may have a supportive family and a home where they can sleep in at night. So instead of occupying an acute bed 24/7, we can refer them to the Day Hospital, where they'll get all the intensive acute interventions they need, but still go home at night and sleep in their own bed."
Dr. White, a former Alberta Medical Association (AMA) President, Past President of the Canadian Psychiatry Association (CPA) and previous Chair of the University of Alberta's Department of Psychiatry, says he is pleased with the early results from the Day Hospital.
"The Day Hospital seems to be functioning exactly the way we wanted it to. We're catering to people who are acutely mentally ill but who are not at risk, and we're also dealing with patients who are transitioning from Inpatient Care into the community," he says.
"We've also had a number of patients who have had to be certified and sent to hospital. That's where the risk assessment process (for suicide or potential self-harm) is so important. Each patient is seen by a psychiatrist at the time of referral, and we do a formal risk assessment then. I've been involved in two cases where we had to send patients back to hospital."
To meet the expected growth in demand for services, AHE has offered positions to a number of physicians at the Day Hospital. One is expected to start in early March, and two others are likely to begin working on a half-time basis in April, says Dr. White.
Like similar facilities in Calgary and Vancouver, the Day Hospital will ultimately be staffed by a full multi-disciplinary team including psychiatrists, psychologists, social workers, occupational therapists and others, with an emphasis on rapid patient transition back to the community.
The Day Hospital is the first of several major initiatives being launched by AHE as part of its Ambition 2023 project. It was unveiled last year, in response to a challenge from Dr. Verna Yiu, AHS's President and CEO, to make AHE more relevant and responsive to individuals and families in the Edmonton Zone who are grappling with complex addictions and mental health challenges.
"Our core strength at Alberta Hospital Edmonton is dealing with the chronically mentally ill, but Ambition 2023 is widening the template here, into the Zone and the broader community. It's an Edmonton-based Zone initiative," says Dr. White.
"The initial vision with Ambition 2023 was to have two Day Hospitals, one here at Alberta Hospital and the other in the city. Funding was only available for one at present, but additional funding may be available if the Day Hospital makes clinical and economic sense."
Ambition 2023 is built around five "pillars" or key priorities. In addition to the Day Hospital, they include:
• Neuropsychiatry & Neuropsychology: Under the Edmonton Neuro-Cognitive Disorders Enterprise (ENCoDE), clinicians aim to address a major gap in diagnostic, treatment and monitoring services for people whose psychiatric disorders are linked to cerebral pathology.
• Redefining Tertiary Care in Psychiatry: Physicians and staff in Tertiary Care are working to realign rehabilitation treatment, programming and clinical processes to better meet the needs of those with intellectual disabilities and/or mental health issues.
• Young Adults: AHE has a unique acute care unit for patients aged 16 to 26, complementing various community-based young adult services. Inpatient enhancements at AHE are planned.
• Targeting Treatment-Resistant Psychosis: AHS Addiction and Mental Health and the Department of Psychiatry are working jointly on an evidence-based holistic treatment for treatment-resistant psychosis.
"What we will be doing in the very near future is a research project where we will be looking at all the data that is now being collected from a systemic perspective to see what effect the Day Hospital is having, not only clinically but statistically, so we get a clearer picture of the difference it is making on demand for Inpatient beds. But the initial anecdotal evidence is that it's already having a very positive effect."
Dr. Melanie Marsh-Joyal, President of the Alberta Psychiatric Association and Emergency & Consultation Liaison Psychiatrist at the Royal Alexandra Hospital, welcomes the new Day Hospital and applauds the collaborative approach taken by team leads Mike Mach and Dr. Daniel Li in bringing it to life.
"What we have appreciated about Dr. Li and Mike is the value they have clearly placed on the importance of collaboration between our teams. They have been actively seeking our feedback and looking for ways to enhance process and ultimately enhance our ability to provide safe, evidence-based, seamless patient care," says Dr. Marsh-Joyal, who also serves as an Assistant Clinical Professor in the Department of Psychiatry.
Nonetheless, she says it's too early to know with certainty if the Day Hospital will ease demand for Emergency Psychiatric Services in the Edmonton Zone. "We will have a much better sense of the impact on our Emergency Departments after a solid eight to 12 months of the Day Hospital being operational."