It’s no secret that our emergency departments are busy. Many patients come in every day. It’s taking longer to move patients from our hospitals to more appropriate places for their care. That means it takes longer to find beds for new patients who need to be admitted.
This happens for a variety of reasons and many people are working to address these challenges. One of the most successful ways to reduce pressure on our emergency departments is also one of the simplest: keep patients who don’t need to be in the hospital out of the hospital.
Enter Dr. Atul Sunny Luthra.
Dr. Luthra, a consultant geriatric psychiatrist at St. Peter’s Hospital (SPH), specializes in understanding what it means when patients living with dementia start presenting uncharacteristic behaviours, such as performing tasks from previous careers or becoming confrontational. He understands the impact untreated behaviours can have on patients, their families and care givers, and, ultimately, how they can increase a person’s likelihood of ending up in an emergency department.
It’s important that we serve them where they are
This is why he’s spent the past 20 years developing an innovative patient-centred partnership based on an old-school approach: house calls.
“Dementia is a journey,” he says. “It’s the latter half that is often the most challenging and complex with regard to behavioural changes. Many of these patients are in a fragile state. It’s important that we serve them where they are.”
Working collaboratively with the Behavioural Health Program at SPH, Dr. Luthra’s geriatric outreach team has built relationships with long-term care homes in the Hamilton area. When a patient starts presenting behaviours outside their normal character, staff at the care facility make a call to the outreach team. A case manager will then spring into action to assess the patient, looking at their medical history, current medical issues and conducting comprehensive discussions with the family and the patient’s care team at the facility.
We couldn’t do this without them
“The person often gets lost behind the disease. We really need to understand who they were before the dementia presented itself,” says program case manager Melanie Charron. “We rely on the families and our partners at the care facilities to help us paint this picture. We couldn’t do this without them.”
The case manager’s assessment allows Dr. Luthra to understand the type of intervention needed. For many patients, the behaviours can be stabilized in their home through a range of therapy approaches.
For higher-risk or complex behaviours, the patient is brought to SPH on a short-term basis for treatment under the expertise of Canada’s largest complex care behavioural program.
“Our staff can implement changes to a patient’s care plan with the goal of reducing the responsive behaviours without decreasing functional abilities,” says Liz Mersereau, clinical manager at SPH. “We work towards building a care plan that can be replicated in the patient’s home or long-term care home, creating continuity of care for the patient while assisting with their safe transition home.”
We have a lot to learn about this disease
The results of the program speak to its effectiveness. Since it began, 98% of patients involved have never seen the inside of an emergency department as a result of their behaviours. Ultimately, this means less stress on patients, their families and the health system as a whole.
“The future of acute medical care will be determined by how well we are equipped to deal with dementia,” says Dr. Luthra. “We have a lot to learn about this disease and those who suffer with it, but we are optimistic based on our findings. Hopefully, our program will help other areas of care progress along this path.”