Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Reducing Pediatric Mental Health Readmissions at Dayton Children’s

Transcript

Reducing Pediatric Mental Health Readmissions at Dayton Children’s · Becker’s Healthcare -- Pediatric Leadership Podcast

• 0:00
  Welcome to the Becker's Healthcare podcast. I'm Chris
• 0:02
  Sosa, your host, and I'm thrilled to be
• 0:03
  joined today by doctor Kelly Sandberg, chief medical
• 0:06
  quality officer and a pediatric gastroenterologist
• 0:08
  at Dayton Children's,
• 0:10
  and his colleague, doctor Katie Winter, division chief
• 0:12
  of psychiatry
• 0:13
  at Dayton Children's.
• 0:14
  Kelly and Katie, thank you for joining us
• 0:16
  today.
• 0:16
  Pleasure to be here. Thank you.
• 0:19
  Wonderful.
• 0:20
  So for those in our audience who are
• 0:22
  maybe not familiar, could you please introduce yourselves
• 0:25
  and give us a little bit about your
• 0:26
  background? Kelly, let's start with you.
• 0:29
  Hi. I'm Kelly Sandberg. I've been a quality
• 0:31
  officer at Dayton Children's for the last, almost
• 0:34
  twelve years now.
• 0:35
  I've been involved in developing some of the
• 0:37
  infrastructure for quality improvement, process improvement, quality assurance,
• 0:41
  and, currently developing an institute of quality and
• 0:44
  safety.
• 0:45
  And Katie. Great. Hi. Thank you so much
• 0:47
  for having us.
• 0:49
  My name is Katie Wenner. I'm the chief
• 0:50
  of psychiatry here at Dayton Children's.
• 0:53
  My training is primarily in child and adolescent
• 0:55
  psychiatry and then also adult psychiatry.
• 0:58
  And most of my clinical time is spent
• 1:00
  on the inpatient mental health unit.
• 1:03
  Excellent. Thank you for sharing that, Kelly and
• 1:05
  Katie. So we have you on the podcast
• 1:07
  today to discuss everything. Well, maybe not everything,
• 1:09
  but the important things most important things Dayton
• 1:11
  Children's is doing in reducing mental health readmissions.
• 1:15
  So there are a lot of different ways
• 1:16
  we can go. But let's just start with
• 1:18
  what initiatives on that front have been successful.
• 1:21
  Kelly or Katie, just take it away.
• 1:24
  Alright. So,
• 1:26
  we have done a lot here at Dayton
• 1:28
  Children's. Things have really changed in the last,
• 1:30
  actually since 2019.
• 1:32
  That is when we opened our inpatient unit.
• 1:36
  And in that time, we realized pretty quickly
• 1:38
  that we did have a problem with the
• 1:40
  remissions,
• 1:41
  and kids kinda coming back and not getting
• 1:43
  what they needed out of the first time
• 1:44
  around.
• 1:45
  And so we actually did publish a paper,
• 1:48
  looking at some of our initiatives that we
• 1:50
  did in quality improvement on the unit.
• 1:52
  And so some of the things that we
• 1:53
  did here were, remission programming. So
• 1:57
  most inpatient units will do the same programming
• 2:00
  kind of over and over. We're like Groundhog's
• 2:01
  Day. You wake up. You go to groups.
• 2:03
  You do the same kind of groups. The
• 2:05
  next day, you wake up and do groups,
• 2:06
  maybe a little bit different, but similar topics.
• 2:09
  So what we looked at was trying to
• 2:11
  come up with a more individualized plan for
• 2:13
  the kids that came back to us to
• 2:15
  really be able to
• 2:17
  better understand what didn't hit the mark, what
• 2:20
  problems did we not address last time they
• 2:22
  were here, and then how do we make
• 2:24
  changes so that we're not doing the same
• 2:26
  thing over and over again expecting different outcomes.
• 2:30
  One of the other initiatives that we looked
• 2:32
  at were, follow-up phone calls. So this is
• 2:35
  something that is pretty simple, but when families
• 2:37
  are here on our unit,
• 2:39
  or in any hospital setting, they're in crisis.
• 2:42
  And so it is very challenging for them
• 2:44
  to be able to absorb all the information
• 2:47
  that and everything that's going on around them.
• 2:50
  So what we started doing was when a
• 2:52
  family leaves, we try to give them a
• 2:53
  call anytime between twenty four hours or seventy
• 2:56
  two hours after they leave just to review
• 2:59
  how, you know, the discharge information that they
• 3:01
  have. Can you make the follow-up appointments? Were
• 3:03
  you able to get your medications?
• 3:05
  Just to problem solve to make sure there
• 3:07
  are no issues that we might be able
• 3:09
  to
• 3:09
  address before another crisis,
• 3:12
  appears.
• 3:13
  We also looked at our group structure itself.
• 3:16
  So part of our quality improvement was collecting
• 3:19
  data of why are these kids coming in.
• 3:22
  And what we found was
• 3:24
  conflict. There was conflict at home. There was
• 3:26
  conflict at school. There was conflict with peers,
• 3:29
  teachers, and kids did not have the tools
• 3:32
  that they needed to be able to deal
• 3:34
  with that conflict.
• 3:35
  So we added conflict management into all of
• 3:38
  our groups for every child to ensure that
• 3:40
  they had the communication skills, the empathy, and
• 3:43
  anger management
• 3:44
  to try to better deal with what was
• 3:46
  going on in their lives.
• 3:48
  And then the last one that we really
• 3:50
  looked at was
• 3:52
  a remission checklist, and this was really just
• 3:54
  a way to standardize what we were doing
• 3:56
  and make sure that no matter who you
• 3:57
  got assigned to your treatment team, you got
• 4:00
  the same options for aftercare,
• 4:03
  available to you.
• 4:04
  Katie, thank you for taking us through all
• 4:06
  of that. And so I have follow-up question
• 4:08
  on that.
• 4:08
  Just given when you started in 2019, was
• 4:11
  there a certain
• 4:12
  model from another department, another health system, hospital,
• 4:15
  anything like that that you look to? Or
• 4:17
  tell us a little bit about how you,
• 4:19
  built that program with those four steps that
• 4:21
  you mentioned.
• 4:22
  Yeah. So, I will say our collaboration within
• 4:26
  mental health, we are a small group
• 4:29
  of mental health providers across the country. And
• 4:31
  so, there are children's hospital collaboratives
• 4:34
  that, we get together with. Ohio is wonderful
• 4:38
  and that we have five pediatric hospitals that
• 4:41
  we talk to on a pretty regular basis
• 4:44
  about
• 4:44
  what they're experiencing, how they did things.
• 4:47
  And so we
• 4:49
  we went to a lot of these hospitals.
• 4:51
  We observed what they were doing.
• 4:53
  We've reached out. We asked questions.
• 4:56
  And so we leaned very heavily on others'
• 4:58
  learnings
• 4:59
  and trying to make the best program that
• 5:01
  we could make.
• 5:03
  Makes total sense. Kelly, Katie, so next question
• 5:06
  I have for you is now that you've
• 5:07
  come as far as you have,
• 5:09
  how do you think Dayton Children's is going
• 5:11
  to be able to build on the success
• 5:13
  that you've had?
• 5:15
  So,
• 5:16
  obviously, as I mentioned, we started this back
• 5:18
  in 2019,
• 5:19
  and it has been a process. The world
• 5:21
  has changed quite a bit in that time
• 5:23
  period.
• 5:24
  And our families have changed, what the needs
• 5:27
  of the kids in our community have changed,
• 5:29
  and then the resources have also changed.
• 5:32
  So
• 5:32
  despite that, we are still doing pretty much
• 5:35
  every one of those initiatives, but we've expanded
• 5:37
  them.
• 5:38
  And so I'll take the phone calls for
• 5:39
  instance.
• 5:40
  The phone calls we started off on our
• 5:42
  unit, but now we do them throughout all
• 5:46
  of pretty much Dayton Children's. But one of
• 5:48
  the places that we really expanded to, first
• 5:50
  off, was our crisis center. And our crisis
• 5:53
  center is, kind of like a psychiatric emergency
• 5:56
  room,
• 5:57
  where two thirds of those kids actually go
• 5:59
  home.
• 6:00
  And so we are now calling them to
• 6:03
  make sure that they understand
• 6:05
  what discharge instructions, making sure that they're able
• 6:08
  to get into those providers so that they're
• 6:10
  not into another crisis.
• 6:12
  As we I already mentioned, the collaboration
• 6:15
  piece is is huge.
• 6:17
  We have been working with all of the
• 6:20
  Ohio hospitals.
• 6:21
  You know, how do we continue to move
• 6:23
  forward and make sure that we are taking
• 6:25
  ideas and sharing ideas when it works. And
• 6:27
  then I will say the other piece of
• 6:29
  this
• 6:30
  project that I feel like was really just
• 6:32
  eye opening was
• 6:34
  that it's not difficult to put quality improvement
• 6:37
  into pretty much every practice, routine practices. So
• 6:40
  it has now become part of
• 6:42
  our leadership,
• 6:44
  on the mental health unit,
• 6:46
  where we use things like the tools we
• 6:48
  had, the checklist, standardizations,
• 6:50
  and we built dashboards. That way, we can
• 6:53
  monitor and make sure we're running an efficient
• 6:55
  system that is providing
• 6:57
  the care that we need to provide.
• 7:00
  Chris, another thing, as we're talking about building
• 7:02
  on success, you know, Katie has talked a
• 7:04
  lot about inpatient, and she just mentioned the
• 7:07
  crisis center just a second ago. But she,
• 7:09
  of course, is in charge of a lot
• 7:12
  more than just those two areas as well.
• 7:14
  She does,
• 7:15
  intensive outpatient.
• 7:17
  They have an outpatient day treatment program. They
• 7:19
  have counseling services. They have other things. So
• 7:22
  part of the reason why,
• 7:24
  you know, there there's a broader system and
• 7:27
  a broader support in place that does support,
• 7:30
  the work that's going on in both the
• 7:32
  crisis center and the inpatient unit.
• 7:35
  I I think,
• 7:37
  also that and Katie, correct me if if
• 7:40
  I'm speaking out of turn here, but there
• 7:42
  are are plans
• 7:43
  to, expand,
• 7:45
  the mental health, beds. And so, you know,
• 7:47
  if we've been successful, then we should be
• 7:50
  able to,
• 7:51
  help the community by expanding,
• 7:53
  you know, that resource,
• 7:55
  as well as offering community additional resources with
• 7:58
  respect to mental health and,
• 8:00
  starting to tackle some of the social drivers
• 8:02
  of of health.
• 8:04
  Yes. I I agree that we have been
• 8:06
  able to expand, and and I don't wanna
• 8:09
  say there was every part of it was
• 8:11
  easy. But the actual patient care piece of
• 8:14
  it, the how to make sure that we
• 8:16
  are doing the same things in one location
• 8:19
  or with 24 beds versus 48 beds once
• 8:21
  we get there. I feel because we have
• 8:23
  become more efficient, it's become an easier system.
• 8:26
  So that expansion has not been taxing on
• 8:29
  the teams.
• 8:30
  It's been easier to ensure that we are
• 8:34
  doing, you know, the same thing and that
• 8:36
  we have fidelity in what we're doing. So
• 8:39
  I very much appreciate you qualifying and clarifying
• 8:41
  that, Katie. I'm sure thankfully, I don't think
• 8:44
  our listeners hear this and think, oh, this
• 8:46
  was easy. I think they understand very much
• 8:48
  so that any part of the job that
• 8:50
  that you both are doing and others in
• 8:52
  your position are doing is is very difficult.
• 8:54
  But I do certainly, you know, there there's
• 8:56
  much to be said for the way you
• 8:58
  laid it out.
• 8:59
  Katie, I do wanna follow-up with you on
• 9:00
  something. So
• 9:02
  obviously, no one can monitor all the phone
• 9:04
  calls that are happening and that I mean,
• 9:05
  between the two of you. But
• 9:07
  when you're taking in the feedback at Dayton
• 9:10
  Children's,
• 9:11
  what have you heard from patients that says
• 9:14
  to you, hey. This is really working for
• 9:16
  us and for them, more importantly.
• 9:19
  So I will say just today,
• 9:22
  I had,
• 9:23
  been reviewing. We we do,
• 9:26
  patients can, you know, review us and give
• 9:28
  us scores. And one of the comments actually
• 9:30
  was about the phone calls
• 9:32
  and how they felt so much wrap around
• 9:36
  from our
• 9:37
  team that they were calling just to check-in
• 9:39
  on their child
• 9:40
  and to make sure that they really had
• 9:42
  the tools available to them that they needed.
• 9:44
  And so it was really nice to just
• 9:46
  kinda see that full circle,
• 9:49
  that what we're doing does matter to the
• 9:52
  families.
• 9:54
  No doubt. No. That's wonderful to hear.
• 9:56
  Lastly, I simply wanna ask you both, just
• 9:58
  given your experience now since 2019 and and
• 10:01
  stretching back further if you prefer.
• 10:04
  What advice do you have for other health
• 10:05
  systems, other organizations who are looking to launch,
• 10:08
  similar initiatives? So, Kelly, let's start with you
• 10:11
  there.
• 10:12
  I think from a system standpoint,
• 10:15
  especially from,
• 10:17
  you know, the mental health standpoint, objectively listening
• 10:19
  to frontline leaders.
• 10:21
  And in that in this case, you know,
• 10:23
  it it's not just doctors and nurses, but
• 10:26
  it's also the therapists and the community health
• 10:28
  workers and others,
• 10:30
  to understand
• 10:31
  kind of the pain points and understand what
• 10:33
  it is that we're trying to do.
• 10:35
  And then, you know, at some point along
• 10:37
  the way, you know, I'm not a mental
• 10:39
  health provider, but yet I I can serve
• 10:41
  as a as a sounding board and someone
• 10:43
  to check assumptions against.
• 10:45
  So Katie had mentioned,
• 10:48
  you know, something about conflict management.
• 10:51
  That was not initially inherent until we had
• 10:54
  some robust back and forth discussions and questions
• 10:57
  and answers.
• 10:58
  And so having kind of, someone who's not
• 11:00
  necessarily a subject matter expertise, but perhaps,
• 11:04
  you know, an expert in quality improvement or
• 11:06
  process improvement,
• 11:08
  or safety can be really helpful.
• 11:11
  I think also finding the key stakeholders in
• 11:13
  the community, whether they be from other surrounding
• 11:15
  hospitals,
• 11:17
  in the community or as, Katie has mentioned,
• 11:20
  you know, the children's hospitals have a lot
• 11:22
  of great collaboratives.
• 11:24
  You know, a lot of us are dealing
• 11:25
  with the same challenges and the same
• 11:28
  restraints.
• 11:29
  And so just understanding what others are doing
• 11:32
  and listening and agreeing that we're here to
• 11:34
  take care of, you know, patients, take care
• 11:37
  of kids.
• 11:38
  Those, you know, key stakeholders in the community
• 11:40
  could also include, you know, organizations that support
• 11:41
  homelessness or group homes or seeing how, you
• 11:42
  know,
• 11:43
  homelessness
• 11:44
  or group homes or seeing how, you know,
• 11:47
  and understanding what their challenges are so that
• 11:49
  we could better,
• 11:51
  you know, work together for, for the kids.
• 11:54
  And then finally, you know, working with appropriate
• 11:56
  government leaders to ensure that they understand,
• 11:59
  the realities of of providing care,
• 12:02
  in 2026.
• 12:04
  It's an ever changing landscape and if they,
• 12:07
  you know, if the decision makers in government
• 12:09
  don't have,
• 12:11
  a clear line of sight into what's going
• 12:12
  on, especially in the mental health spaces,
• 12:16
  we're really,
• 12:17
  kind of a a two hit on that,
• 12:20
  where we're first hit from, you know, not
• 12:22
  having the need needed resources, but also not
• 12:24
  having the understanding when,
• 12:26
  you know, legislation is brought forward.
• 12:29
  Makes a lot of sense, Kelly. Thank you
• 12:30
  for laying out all those steps, on from
• 12:33
  the operational standpoint. It's very, very helpful. Katie,
• 12:36
  I'm looking forward to hearing what you add
• 12:38
  to this as well.
• 12:39
  Yeah. I I feel like my answer to
• 12:42
  kinda how to give advice to this, is
• 12:44
  probably
• 12:45
  very simple. It's sometimes just jumping in, finding
• 12:49
  something that you're passionate about, and then finding
• 12:51
  a mentor.
• 12:52
  So Kelly was the mentor in this. Kelly
• 12:55
  has been the cheerleader in this despite not
• 12:57
  being,
• 12:59
  a mental health, you know,
• 13:01
  practitioner. He has encouraged us to really, you
• 13:04
  know, jump in, look at the data, and
• 13:06
  really get together and think of what can
• 13:09
  we do.
• 13:11
  As he mentioned, resources aren't always available, but
• 13:13
  there are small changes, things like a phone
• 13:15
  call that don't take a lot of resources
• 13:18
  that you can make a difference.
• 13:21
  So I just encourage people to really just
• 13:23
  think about what
• 13:25
  problems they feel like they have in the
• 13:27
  system and see how, you know, even that
• 13:30
  small change might actually make a big impact.
• 13:34
  Excellent advice to be sure no one can
• 13:35
  do any of this all by themselves. And
• 13:37
  clearly, you guys have gotten a long way,
• 13:39
  looking not only to each other, but, other
• 13:42
  people,
• 13:43
  who have been very helpful.
• 13:44
  Kelly, Katie, thank you so much for being
• 13:47
  on the podcast today.
• 13:48
  Thank you very much, Chris. It's been a
• 13:50
  pleasure. Thank you.