HHC Announces First Phase of Reforms to Improve Quality of Care for Mental Health Patients at Kings County Hospital
Feb 05, 2009
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- Highlights of the Behavioral Health Program Reform Plan
- Remarks by HHC President Alan D. Aviles
New York City Health and Hospitals Corporation President Alan D. Aviles today marked the opening of the new $153 million psychiatric center at Kings County Hospital and announced significant improvements achieved in the first phase of a comprehensive eight-point plan to transform mental health services, improve quality of care and radically change the patient experience for the 12,000 New Yorkers served by the hospital’s behavioral health program every year. The changes represent the most dramatic overhaul of mental health services the program has received in its nearly 70 year history.
Noting that the true transformation at Kings County Hospital would go beyond the long overdue replacement of the antiquated “G” building, Aviles announced a complete overhaul of the decades-old staffing model, a new approach to safety and security, a new leadership team, a significant increase in staff, and dramatic improvements to emergency room services. The second phase of the reforms will include new resources to better manage the chronic medical conditions of mental health patients, the use of Peer Counselors to serve as patient navigators and mentors, and the creation of a Consumer and Family Advisory Group. Aviles was joined by the newly appointed Kings County Hospital Executive Director Antonio Martin and Dr. Joseph Merlino, the newly appointed Director of Behavioral Health Services.
“During the past year, we have been focused on the design and implementation of sweeping and radical change in the delivery of behavioral health services at Kings County. Those efforts took on even greater urgency with the tragic and inexcusable neglect and death of Esmin Green in this hospital’s psychiatric emergency department seven months ago. Today, we not only unveil a dramatically transformed physical environment, but a fundamental redesign of the way we have delivered mental health services for decades. As we relocate psychiatric services into this modern facility, we are turning a page and putting into place a culture of patient-centered care, a culture anchored in compassion, respect and an emphasis on sustainable recovery for patients to help them re-integrate with their community,” said HHC President Aviles.
The reforms completed under the first phase of the redesign plan include:
- Further relief of overcrowding and the expansion of therapeutic activity space with completion of the 300,000 square foot Behavioral Health Center Pavilion, which will house the Comprehensive Psychiatric Emergency Program (CPEP), the 230 inpatient beds and the outpatient services that are now spread out over seven separate hospital buildings.
- The addition of more than 200 new doctors, nurses, psychologists, social workers and other staff.
Better coordination with EMS and other components of the mental health system, adequate staffing ratios, more expeditious triage, assessment and treatment that have led to a dramatic reduction in overcrowding in the psychiatric emergency room. The average number of patients in the psychiatric emergency room generally does not exceed 25 patients at any given time. Patient census before these changes went as high as 50 or more. The average length of time patients stay in the CPEP – which includes triage, evaluation, treatment and disposition to next level of care — is down to less than 8 hours compared to an average of 27 hours one year ago.
- A further reduction of overcrowding and capacity expansion with priority access to 24 crisis beds at Kingsborough Psychiatric Center (KPC), jointly staffed by Kings County and KPC.
- Reduced reliance on hospital police to manage patients in crisis with deployment of new, non uniformed and specially trained personnel who have clinical, crisis intervention and security skills.
The second phase of the reforms, which will be implemented over the next year, include:
- A new care coordination model to link mental health patients with internists to better manage the chronic medical conditions that often go untreated among the mentally ill.
- The addition of Peer Counselors, full time staff who been mental health patients themselves and will now serve as navigators, mentors and patient advocates.
- The creation of a new Consumer and Family Behavioral Health Advisory Council to formally engage mental health advocates, patients, families, and members of the local Central Brooklyn community.
- Increase psychiatric emergency service capacity in Brooklyn by creating a new Comprehensive Psychiatric Emergency Program (CPEP) at Woodhull Hospital.
- Expand and strengthen case management and social work service team to assist and support patients as they make the transition back into the community, help prioritize access to specialized supportive housing, community crisis beds, and case management.
- Publicly report performance measures in behavioral health for Kings County and the entire HHC system. Post such data on HHC’s transparency webpages, www.nychhc.org/hhc .
“The new model of care will help ensure that every patient gets the focused attention they deserve – from the minute they enter the emergency room, throughout their stay in a hospital inpatient unit, and to their outpatient follow-up,” Aviles added.
The comprehensive plan addresses many of the conditions identified in legal action brought against Kings County by mental health advocates and echoed in subsequent reports and investigations conducted by the New York State Department of Health, New York State Department of Mental Health and, most recently, the U.S. Department of Justice. As part of the reforms, the facility in which Esmin Green tragically died last June will be closed down next week.
The over-arching plan which will transform Kings County psychiatric services is organized around eight broad areas of reform:
- Ensure the safety and security of both patients and staff;
- Establish a reform-minded leadership team, ensure adequate staff, build expertise and accountability;
- Radically change the psychiatric emergency room experience to ensure prompt, effective assessment and treatment;
- Provide evidence-based, patient and family-centered care focused on recovery and rehabilitation;
- Strengthen chronic disease care and address underlying medical conditions;
- Involve patients and their families more directly in the design of care;
- Increase accountability and transparency;
- Assist and support patients as they make the transition back into the community.
“We know that the model therapeutic environment we are determined to create does not come easily, but with strong leadership, new protocols, increased training, adequate staffing ratios and a modernized facility the pieces to a complicated puzzle are coming together. I am confident that our new team – made up of individuals who have the heart and expertise to care for individuals with complex mental health needs – is ready to meet the challenge,” Aviles added.
Contact: Ian Michaels (HHC)
About Kings County Hospital Center
Kings County Hospital Center (KCHC) is a 627-bed facility that serves the communities of Central Brooklyn, East New York-New Lots and Flatbush. KCHC, a teaching hospital, is part of the NYC Health and Hospitals Corporation (HHC). KCHC is a Level I Trauma Center for Adults and the only Level 1 Pediatric Trauma Center in Brooklyn. It is a NYSDOH Designated AIDS Center; a Stroke Center; and has also been designated as a Center of Excellence for Diabetes and for Parkinson Disease. KCHC has played a major role in providing health care to vulnerable populations in Brooklyn since 1831. For more information visit www.nychhc.org/kchc.
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlusHealth, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.