Three Ways to Improve Transitions from Detox to Continuing Care

March 4, 2016

Maureen Fitzgerald
Communications Coordinator, ATTC Network Coordinating Office
Editor, NIATx


In fall 2014, baseline data showed that only 33% of  Ministry Behavioral Health clients in Stevens Point, Wisconsin, transferred from detoxification services to continuing care. Ministry Behavioral Health is a department of Ministry St. Michael’s Hospital. It works closely with the hospital’s inpatient mental health and acute care units, which include a detox department.
Participating in a NIATx project helped the Change Team boost continuation to continuing care to 63% by June 2015 - an increase of 91%.

How did they do it?  “Rapid-cycle testing was key,” says Change Leader Kathleen Olszewski, MBA, CRCE-I Manager of Business Operations at Ministry Behavioral Health.
Three effective changes (based on NIATx Promising Practices) that emerged from their rapid cycle series include: 
1. The Consult Log: A counselor completes a consult with each detox patient.  All patients in the detox unit for more than one day receive daily follow-up visits. The Consult Log documents the status of the consult and informs the next counselor of follow-up needs. A counselor on the change team created the log, tweaking the design several times throughout the change project.
Says Kathy, “In the past, if a patient said they weren’t interested in follow-up care at the first consult, we’d take their word and not offer it again. But with the Consult Log, we asked every day and recorded the patient response.  It showed us that it really pays to keep asking the question. We were amazed at how many patients changed their minds and were willing to make aftercare appointments by the third day.”
2. A warm handoff: A walk-through of the discharge process gave the change team ideas on how to improve the discharge process.  “Previously, a discharge planner would schedule an outpatient appointment and just hand the patient an appointment card with the time and date of the after care appointment,” explains Kathy. “It seemed like a very cold and impersonal process.”
Now, a counselor provides information on what to expect in aftercare and makes the continuing care appointment with the patient before discharge.  “They ask the patients if they prefer a male or female counselor and also address barriers that patients might face, like transportation or childcare issues,” adds Kathy.
In addition, to reduce delays between detox services and continuing care, there’s an outpatient appointment available at 1:00 pm every day.  “This makes it possible for patients to start their aftercare almost immediately after discharge at noon,” comments Kathy.
3. Counselor Bio Cards: The change team recognized patients’ lack of information about what to expect as a significant barrier to continuing care. To provide information and strengthen the warm handoff, the team created “bio cards.” The large cards (approximately 3.5 x 8 inches) are printed in color on high-quality, heavy paper.  They include the counselor’s photo, biographical information, and a statement from the counselors on their treatment philosophy or why they chose the profession.
“The bio cards have been a big hit with the patients, and we’re now getting requests to create them for doctors from other departments in the hospital,” says Kathy.
Kathy has participated in a number of quality improvement projects over the years but this was her first experience with the NIATx model.
“Other quality improvement projects can get to be really long and drawn out, with a lot of time spent in meetings where you don’t see results,” says Kathy. “What I liked best about NIATx was that if it looked like one of our rapid cycles wasn’t working in three days, we changed it.” 
The change team did encounter some resistance at first, as many of the counselors have been with Ministry Behavioral Health for many years and were accustomed to long-established processes.  Kathy credits the change team for their commitment to the success of the project.
“It really was a team effort for all of the treatment providers and my staff in the business office,” says Kathy. “This project has shown us that we could use the NIATx model for any process that we want to improve.”
The Ministry Behavioral Health team is one of several Wisconsin change teams that participated in the pilot project to improve transitions from detox to continuing care. NIATx Deputy Director Todd Molfenter is leading the project with NIATx researcher Mark Zehner. They’re working in partnership with the Wisconsin Department of Health Services, the Wisconsin Department of Family Medicine, and detoxification treatment facilities throughout Wisconsin.
This story first appeared in the March 2016 NIATx E-news. 

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