Helping Patients With Behavioral Health Needs

In my last blog, I discussed the issue of Emergency Department (ED) overcrowding and its causes. One of the reasons why people might wait at the GBMC ED is because we are overwhelmed with behavioral health patients who have nowhere to go because the mental health system is inadequate. What is GBMC doing to improve this situation?

There is a wide range of disorders and severity in the category of mental health and substance abuse. A patient may experience a new onset depression that if we address early may be easy to treat and resolve. At the other end of the spectrum, we have patients with disorders like autism and schizophrenia that are chronic diseases that require long-term attention and treatment.

We have made a promise to our patients in advanced primary care – in our patient-centered medical homes to own the patient’s health with him or her. This goes for all health issues including mental health.

The GBMC advanced primary care practices are conveniently located throughout Baltimore County, with offices both on our hospital campus and in the community.  They have extended weekday and weekend hours to be available to those they serve as the need arises. The typical primary care office is not designed to care for patients with mental health needs. Primary care physicians often lack the time or expertise to effectively counsel patients with behavioral issues.

So, the GBMC HealthCare System received a grant from the Health Services Cost Review Commission to add mental health professionals to the advanced primary care team. The grant is providing the resources for working closely with Sheppard Pratt Health System, Mosaic Community Services, and Kolmac Outpatient Centers to proactively address the behavioral health needs of our patients. Together, we are integrating behavioral health services in GBMC primary care offices and working to better connect patients to specialty programs.

We are in the process of adding new team members to the primary care practices: full-time behavioral health consultants who are licensed social workers and consulting psychiatrists, from Sheppard Pratt, and substance use consultants from Kolmac and Sheppard Pratt. The primary care physicians will refer patients to the onsite behavioral health consultant and he or she will bring in the psychiatrist as needed if counseling (motivational interviewing, behavioral activation, problem-solving therapy) alone is not enough to meet the patient’s needs.

The substance use consultant will be engaging patients in counseling (motivational interviewing) and resource navigation. As part of the collaboration with Kolmac, the advanced primary care sites have access to an addiction psychiatrist.

Currently, our Family Care Associates practice on campus and GBMC Joppa Road have all three services. Our practices at Owings Mills, Hunt Manor, and Internal Medicine on campus have the consulting psychiatrist and the substance use consultant. By the end of March, ALL FIVE of these sites will have all three team members. By July, the full program will be implemented at all of our advanced primary care sites. I am very excited that we are adding these professionals to our patient-centered medical homes. Patients with behavioral health needs will be much better served because of them!

Random Acts of Kindness...
Last week, we celebrated our 2nd “Random Acts of Kindness (RAK) Week.” With this year’s event, we engaged even more of our workforce to help spread kindness throughout our healthcare system. Each hospital department, GBMA practice and Gilchrist Services’ locations received a Kindness Kit, complete with tools to be kind to colleagues and those around you. The kits contained candy, KIND bars (generously donated by KIND), and Kindness cards. The cards came in packs of 12 and each contained a unique kind act. Cardholders were encouraged to either do the action on the card or make up their own, check off that they completed it and then challenging someone else to be kind.  I’m looking forward to finding out how some of the cards fared, where they traveled and what wonderful things our employees did for each other.

This year, we also created a new Random Acts of Kindness Ambassador Award. I was told by the RAK Week planning committee that they received many worthy and outstanding submissions of wonderful acts of kindness by our employees, but two stood out above the rest. Congratulations to Ray Morgan (Security) and Amy Gourley (Unit 57 MICU) in being selected as the co-recipients of our first Random Acts of Kindness Ambassador Award.

Thanks for being kind to each other year round and to everyone who helped with this endeavor and for making it such a success!

Food Drive…
Speaking of kindness, just a reminder that in honor of Black History Month, we’ve been accepting donations of canned goods and non-perishable food will that will help the Assistance Center of Towson Churches (ACTC), a consortium of 50 churches that provide support to needy families in our community.  Donations will be accepted until Friday, Feb. 24.  Please consider dropping off non-perishable food items to one of our various drop-off locations in the main hospital or at all GBMC community primary care offices.  For more information, please visit www.gbmc.org/fooddrive. This is truly an important initiative because many local families are in need of food year round.

Why Do People Wait in Emergency Departments?

Last week, there were stories in the media that focused on emergency department (ED) wait times across the country.  One story was about the data collected, from April 1, 2015, through March 31, 2016, by the Centers For Medicare & Medicaid Services (CMS) which showed that Maryland Emergency Department (ED) wait times are the longest in the nation.  According to CMS, patients waited for an average of 53 minutes in Maryland before they were seen by a medical professional compared to the national average of 22 min.  At GBMC, the CMS stats showed that we had an average of 60 minutes during that year before a patient was seen by a doctor or nurse.

To understand the problem of ED overcrowding we should consider the diagram below:

A number of years ago, the Robert Wood Johnson Foundation created this diagram to help people understand the underlying reasons that people wait in emergency departments. Fundamentally, it’s a problem of supply and demand and flow.  Anything that increases the number of patients arriving to be seen will increase the chance of waiting (input), and anything that slows down the assessment and treatment of patients (throughput) or anything that prevents their departure (output) will increase the waiting.

If we want to reduce ED overcrowding. we can start by trying to reduce the number of patients coming to the ED (like we have at GBMC) by making it easy for patients with real needs but who don’t have true emergencies to be seen in primary care. We are now open well into the evening and on Saturday and Sunday. We can also work to make sure everyone has health insurance since people without health insurance come to the ED because many physician offices won’t take them without insurance or they cannot afford to pay out of pocket.

Once we have reduced the number of patients arriving at the ED to only those with true emergencies we should work on the processes within the ED like registration, assessing the patient, and getting needed tests done expeditiously. A recent change that has slowed patient assessment within the ED somewhat is our desire to send more patients out with home care. This requires taking more time with the chronically ill in particular, to assure that they can be safely discharged.

But everyone who has ever studied ED overcrowding knows that the real culprit in ED waiting is the outflow of patients. In most hospitals historically, the single biggest cause of patients waiting in the ED is because patients who need to be admitted are waiting for an inpatient bed to be vacated and cleaned. These patients take up valuable ED space and “block” other patients from being seen. This problem is improved by improving the flow from admission to discharge to bed cleaning on the inpatient units. Sometimes a clean bed is available but a nurse to care for the patient is not, this is being made more common by the nursing shortage.

A relatively new cause of waiting due to outflow from the ED is the lack of mental health beds, especially in the state of Maryland, and notably at GBMC because of our proximity to Sheppard Pratt. On most days in our ED, we have from 5-12 patients waiting for a mental health placement and taking up beds that could be used for the next sick patient coming to the ED. With our present mental health system, there just are not enough beds to cover those in need. Hospitals, like Sheppard Pratt, are always full. When one patient is discharged, there are always others waiting to fill the bed.

In next week’s blog, I will talk about what GBMC is doing to identify and treat behavioral problems earlier to try and reduce the need for mental health beds.

Let’s Give Them Something to Talk About… How About Love?

These days we know that there’s a lot going on in Washington as our lawmakers and the executive branch of government approach our country’s issues. Everywhere you go, people are talking about this. I often turn to music when I am trying to make sense of things. Last week, my wife, Tracey, and I had the good fortune of hearing a concert by John Hiatt and Lyle Lovett. Mr. Hiatt is not very well known as a singer, but he’s written many excellent songs that others have made famous. Bonnie Raitt had a hit, with his song, Something to Talk About. The line in the song “Let’s give them something to talk about - how about love?” is ringing true to me especially now. We need less talk about borders, barriers, blockages, fear and hatred and more about love and kindness.

Just stop and think about all of the acts of love and kindness every day at our hospital, our physician offices and everywhere we care for a hospice patient. What would happen if we got united around stories about love and kindness in our HealthCare system? Could this create a ripple effect that might bring more people together to find workable solutions to our problems?

Earlier this week, I addressed our new GBMC colleagues at new employee orientation. My job at orientation is to begin to enroll my new colleagues in our vision. I always try to engage new employees in a conversation about our transformation towards being the healthcare system that treats everyone, every time the way we want our own loved ones treated. This week, there were nearly 30 new employees joining the GBMC HealthCare family.

Let me share with you some of what I learned about two of our new people.

I had the pleasure of speaking with one of our new Registered Dieticians, Nancy Glaser, who told me that she is excited about bringing diabetes education directly to patients in our Patient-Centered Medical Homes.

Q: Why did you choose to work at GBMC?
A: As a diabetes educator, working with the community is very important to me. GBMC is a community health system and feels like a community health system.  I will be working in the outpatient diabetes center, but also getting out into primary care offices where people with diabetes are seen most often. We're taking the care to the patient and meeting them where they're already comfortable.

Q: So far, as an employee, what are your top 3 impressions of GBMC?
A: 1) Friendly:  Just simple hellos and smiles from so many people really help make GBMC a place where I want to be.
2) Clean and bright:  Walking through the hallways, I see a shine that stood out to me.  The brightness can really help bring cheer to patients that need it.
3) Energetic:  Throughout my hiring process, I have felt the energy in the department of people truly wanting to make a difference.

Q: How do you see your job relating to the organization's mission?
A:  Health, Healing, and Hope:  My goal is to help patients stay as healthy as they can. By finding out what they typically eat and what their daily life is like, together, we can find ways to keep their blood sugars (and blood pressure, weight and other health measures) under control. By working with the patients, they become empowered and it gives them hope that yes, they can do it.

Q:  What do you think will be the best part of working in your department?
A:  Working with a team of educators where we can learn from each other and from the patients to maximize the effectiveness of diabetes education.

Q: Give us a FUN fact about you.
A:  I love to ski, swim and run, and I love watching my kids play soccer and lacrosse and NFL football (Go Ravens!).  I played water polo in high school, but if I tried to play it now, I would probably drown.

I also had the pleasure of meeting Antonio Wood, Sr., who is joining our environmental services team. 

Q: Why did you choose to work at GBMC?
A:  I choose to work at GBMC because the people are friendly and helpful.

Q:  So far, as an employee, what are your top 3 impressions of GBMC?
A:  My top 3 impressions of GBMC are the quality of care, cleanliness and the concern for patients.

Q:  How do you see your job relating to the organization's mission?
A:  In assuring that the patients’ rooms are cleaned properly and sanitized, I will prevent germs spreading from one patient to another. 

Q:  What is/do you think will be the best part of working in your department?
A:  I will do my best in my department to maintain a pleasant work environment.

Q:  Give us a FUN fact about you.
A:  I love eating hard red delicious apples. I enjoy watching football and baseball.

…and Back to Kindness
The start of Random Acts of Kindness Week, February 12–18, is just nine days away! Although we focus on kindness all throughout the year, GBMC HealthCare is celebrating by encouraging kindness among our coworkers.

This year, staff members are asked to submit nominations for the new Random Acts of Kindness Ambassador Award. This is an opportunity to share stories about and recognize a coworker who has gone above and beyond in being kind to coworkers and patients throughout the year. Submissions will be accepted from now until Monday, February 13. Click here to submit a nomination. The winner will be announced on Thursday, February 16.