what crisis should learn from air traffic control

How to Avoid Tragedies and Near Misses

DAVID COVINGTON, LPC, MBA

EXCELLENCE IN HEALTH INFORMATION TECHNOLOGY

Supported by Qualifacts, Inc.Behavioral Health LinkAtlanta, GA

Wide Cracks in the Safety Net

At the end of November following the suicide of his son “Guss,” Virginia Senator Creigh Deeds told CNN that he was alive for a reason and that he would work for change in mental health.

Polling Question #1Virginia Tech, Columbine, Tucson, Aurora, Newtown… We should do the following:

A. Double Mental Health System Capacity

B. Ban Assault Rifles ImmediatelyC. Dramatically Expand MH First AidD. Create Robust, Integrated Crisis

SystemsE. All of the AboveF. None of the Above, as Tragedies Are

Unavoidable

Polling Question #299.9% is a good target for aviation safety:

A. TrueB. False

If US airports settled for a 99.9% success rate for commercial flights, there would be 300 unsafe take-offs and/or landings… per day!

Keeping Individuals from Falling through the Cracks

Individuals walk out of an Emergency Department “Against Medical Advice,” for example, and crisis services shift their focus away to others.

We accept the current system as the best that can be done… It is not.

A Safety Net Requires Accountability

Every time there is a Columbine, Tucson or Sandy Hook, we grieve… and we wring our hands and consider whether there is a better way. It is time to raise the bar and innovate with solutions that will drive a different set of results.

Learning from Air Traffic Control Safety

“Flight 93” chronicled the heroic passengers of a hijacked plane. It also gave an up close view of the way air traffic control works to ensure the safety of nearly 30,000 commercial flights… per day!

Two Key Principles of SafetyGoal #1: always know where the aircraft is and never lose contact;

Goal #2; verify the hand-off has occurred and the airplane is safely in the hands of another.

Without Air Traffic Control Principles Referrals are shotgun faxed to multiple facilities at once,

bogging down w/ paperwork when most will not admit The first facility giving acceptance is where the individual

goes without regard to how far away from family supports No accountability - no way to know if someone is stuck in

an ED unless the staff make noise (squeakiest gets grease) No one knows how many are being sent home w/o care Receiving facility staff may sift through all referrals, and

pick out the ones that will be easier in the milieu

Without Air Traffic Control Principles (Continued) Almost all individuals are sent to the ED for medical

clearance, even if not indicated. No accountability for using the ED as a holding cell

Communication depends on numerous phone calls, faxes. ED staff and crisis facility staff make and field numerous phone calls about each case. If nurses at either facility are busy, the other must wait for call backs. No time frames are set for receiving facilities to give referral decisions

There is no transparency around the census for inpatient Costly, invasive and time consuming medical tests are

often required unnecessarily

FY2010 FY2011 FY2012 FY2013 FY2014

Referrals; 347Referrals; 261

Referrals; 3216

Referrals; 4360Referrals; 4392AMTD; 592

AMTD; 547

AMTD; 316AMTD; 277

AMTD; 166

Modifying the Milbank Continuum for Crisis Coordination “Flight 93” chronicled the heroic passengers of a hijacked plane. It also gave an up close view of the way air traffic control works to ensure the safety of nearly 30,000 commercial flights… per day!

Crisis Access, LLC has modified the Milbank collaboration continuum (original citation Doherty, 1995) for the purposes of evaluating crisis system community coordination and collaboration (see table above).

A Level 5 Crisis System: Close & Fully Integrated

In our model, the highest level requires shared protocols for coordination and care management that are “baked into” electronic processes, not simply add-ons.

Polling Question #3Which of the following elements are required in a Level 5 Crisis System (select all that apply):

A. Intensive Referral TrackingB. 24/7 SchedulingC. Crisis Bed Inventory ToolsD. High-tech Mobile Crisis DispatchE. Real-time Online Outcomes

Dashboards

The Five Components of a Level 5 Crisis System

For a crisis service system to provide Level 5 “Close and Fully Integrated” care, it must implement an integrated suite of software applications that employ online, real-time, and 24/7:

Status Disposition for Intensive Referrals

24/7 Outpatient Scheduling

Shared Bed Inventory Tracking

High-tech, GPS-enabled Mobile Crisis Dispatch

Real-time Perform-ance Outcomes Dashboards

Polling Question #4Without community based mobile crisis services law enforcement and ERs will hospitalize individuals:

A. The Same Amount as if Those Services Were Available

B. Less Likely to HospitalizeC. 2x More LikelyD. 3x More Likely

http://bhlweb.com incorporates all five elements into a single shared online application

http://bhlweb.com

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#1 – Intensive Referral Tracking

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#2 – 24/7 Scheduling

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#3 – Bed Inventory Census

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#4 – High Tech Mobile Dispatch

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#5 – Outcomes Dashboards

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#1 – Intensive Referral Tracking

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#2 – 24/7 Scheduling

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#3 – Bed Inventory Census

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#4 – High Tech Mobile Dispatch

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

#5 – Outcomes Dashboards

Level 5 Crisis

Intensive Referral Status

24/7 Outpatient Scheduling

Bed Inventory Tracking

High-tech, Mobile Dispatch

Outcomes Dashboards

Polling Question #5What are the benefits of a Level 5 Crisis System (select all that apply):

A. Reduce Burden on ERs/Law Enforcement

B. Actionable Intelligence for FundersC. Improve Transparency/Efficiency of

Referral ProcessD. Reduce Unnecessary Phone Calls,

FaxesE. Informed Clinical Decision-making

Contact Us CEO & President David.Covington@recoveryinnovations.org

Social Networking http://davidwcovington.com

http://davidwcovington.com