Access to aftercare in Psychiatric partial hospitalization

The healthcare issue addressed at Bergen New Bridge Medical Center Paramus, NJ (BNBMC) entails timely access to aftercare either in Psychiatric partial hospitalization, (PHP) intensive outpatient (IOP), or outpatient (OP) level of care. The ACA’s focus on increasing and improving healthcare systems remains an issue at BNBMC (Broom & Marshall, 2021). The ACA goal for healthcare in the United States to enhance healthcare access to health rather than disease is germane to expanding resource availability. PHP, IOP, and OP remain limited at BNBMC. PHP evaluations are only available Monday, Wednesday, and Friday. Therefore, a request to expand available PHP appointments to more than three and IOP and OP appointments for evaluations to more than two per week. The inadequacy puts patients at high risk for relapse after leaving the emergency department and in need of inpatient hospitalization.

The leadership proposal is to expand virtual appointments for evaluations for all outpatient levels of care mentioned. Furthermore, the request is for hiring additional staff to accommodate the need for timely appointments to evaluate and have patients begin treatment within the same week they have presented to the emergency department due to a psychiatric crisis. A review of two recent studies regarding the effectiveness of virtual psychiatric care will follow.

First Brief Summary of an Article Supporting Efficacy and Effectiveness to Expand use of Telepsychiatry to Accommodate Healthcare Needs

The broad study of literature found the COVID-19 pandemic has initiated extraordinary healthcare system adjustments benefiting psychiatry for one through telepsychiatry (Chen et al.,2020). The pandemic propelled insurance payment for telepsychiatry by reducing regulations previously prohibiting the same (2020). The research findings show effectiveness, and at times telepsychiatry demonstrates above-average benefits than in-person psychiatric treatment (2020). Psychotherapist and psychiatric clinicians note the advantage of seeing a glimpse into the patients’ lives while in their home environment through virtual treatment connections (2020). Psychiatric clinician reviews of their experience of conducting telepsychiatry provide communication to the leadership of additional needs to effectively provide care (2020). Some of those needs include additional supervision, support and validation, and ongoing research on telepsychiatry care (2020).

Advocacy for the expansion of outpatient providers in psychiatry to comply with enhancing healthcare access to focus on health rather than disease is pertinent to expanding resource availability at BNBMC.

Second Brief Summary of Article Supporting Efficacy and Effectiveness to Expand use of

Telepsychiatry to Accommodate

Transition from in-person to psychiatry’s virtual format during the COVID-19 pandemic thrust upon the healthcare community. The experience has demonstrated the capability of healthcare services to be creative and resilient. Once considered limited out of necessity in remote locations has become the dominant form of outpatient psychiatric treatment. One facility readily adapted to the development of a virtual psychiatric partial hospitalization by patients and clinical staff. Clinical staffs’ creation of protocols for evaluation with the inpatient clinical team to determine patient appropriateness for virtual PHP became routine (Hom et al., 2020). Based on a basic assessment of the patients’ capability to use a smartphone or iPad, focusing and engaging mentally and emotionally came first. Confirmation that the patient had established an outpatient therapist and psychiatric clinician was necessary for the patients’ emergency needs during off-hours (2020). Patients accepted into the PHP were given an orientation while still inpatient to accessing the virtual environment in addition to a packet of written material with a schedule (2020).

Gathering treatment outcome data and patients’ evaluations to determine the effectiveness of this essential modality of treatment will further inform of overall strengths and feasibility to continue virtual PHP, IOP, and outpatient treatment post-COVID-10 pandemic (2020). These activities will serve well to inform leadership and the payor sources of the same. Again, the need to expand virtual psychiatry is at hand to accommodate those patients in need who may otherwise fall through the cracks when discharged without a follow-up plan.

Strategies Used to Address the Organizational Impact of National Healthcare

Issues/Stressors

The national healthcare issue of COVID-19, while striving to reach the ACA focus to increase and improve healthcare systems, remains an issue at BNBMC. The problem existing at BNBMC to accommodate patients discharged from the emergency department with a timely appointment in PHP, IOP, or OP levels of care requires attention…

Assignment: Analysis of a Pertinent Healthcare Issue
The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.
The Assignment (3-4 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.
NURS_6053_Module01_Week02_Assignment_Rubric

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Excellent Good Fair Poor
Develop a 3- to 4-page paper, written to your organization’s leadership team, addressing the selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:
· Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).

23 (23%) – 25 (25%)
The response accurately and thoroughly describes in detail the national healthcare issue/stressor selected and its impact on an organization.
The response includes accurate, clear, and detailed data to quantify the impact of the national healthcare issue/stressor selected.

20 (20%) – 22 (22%)
The response describes the national healthcare issue/stressor selected and its impact on an organization.
The response includes accurate data to quantify the impact of the national healthcare issue/stressor selected.

18 (18%) – 19 (19%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague or inaccurate.
The response includes vague or inaccurate data to quantify the impact of the national healthcare issue/stressor selected.

0 (0%) – 17 (17%)
The response describes the national healthcare issue/stressor selected and its impact on an organization that is vague and inaccurate, or is missing.
The response includes vague and inaccurate data to quantify the impact of the national healthcare issue/stressor selected, or is missing.

· Provide a brief summary of the two articles you reviewed from outside resources, on the national healthcare issue/stressor and explain how the healthcare issue/stressor is being addressed in other organizations.
27 (27%) – 30 (30%)
A complete, detailed, and specific synthesis of two outside resources reviewed on the national healthcare issue/stressor selected is provided. The response fully integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the summary provided.
The response accurately and thoroughly explains in detail how the healthcare issue/stressor is being addressed in other organizations.

24 (24%) – 26 (26%)
An accurate synthesis of at least one outside resource reviewed on the national healthcare issue/stressor selected is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the summary provided.
The response explains how the healthcare issue/stressor is being addressed in other organizations.

21 (21%) – 23 (23%)
A vague or inaccurate summary of outside resources reviewed on the national healthcare issue/stressor selected is provided. The response minimally integrates resources that may support the summary provided.
The response explains how the healthcare issue/stressor is being addressed in other organizations that is vague or inaccurate.

0 (0%) – 20 (20%)
A vague and inaccurate summary of no outside resources reviewed on the national healthcare issue/stressor selected is provided, or is missing.
The response fails to integrate any resources to support the summary provided.

· Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected and explain how they may impact your organization both positively and negatively. Be specific and provide examples.
27 (27%) – 30 (30%)
A complete, detailed, and accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.
The response accurately and thoroughly explains in detail how the strategies may impact an organization both positively and negatively, with specific and accurate examples.

24 (24%) – 26 (26%)
An accurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.
The response explains how the strategies may impact an organization both positively and negatively. May include some specific examples.

21 (21%) – 23 (23%)
A vague or inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided.
The response explains how the strategies may impact an organization both positively and negatively that is vague or inaccurate. May include some vague or inaccurate examples.

0 (0%) – 20 (20%)
A vague and inaccurate summary of the strategies used to address the organizational impact of the national healthcare issue/stressor is provided, or is missing.
The response explains how the strategies may impact an organization both positively and negatively that is vague and inaccurate, or is missing. Does not include any examples.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.

5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
Purpose, introduction, and conclusion of the assignment is vague or off topic.

0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
No purpose statement, introduction, or conclusion was provided.

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Name: NURS_6053_Module01_Week02_Assignment_Rubric
The psychiatry department at Massachusetts General Hospital identified the massive issue encountered of limited technological capacity with the existing platform concerning the enormous demand for telepsychiatry in March 2020 at the beginning of the COVID-19 pandemic (Chen et al., 2020). The leadership approved the Transition to the use of phone calls and commercial platforms such as doxy.me, Doximity, and Zoom (2020). The psychiatric department outpatient had a 22% hike in productivity (2020). BNBMC has kept virtually telepsychiatry at a level they can manage.

BNBMC does need to expand its ability to accommodate a more significant number of patients with telepsychiatry. There could be financial restraints due to the pandemic.

The hospital census has been decreased by not admitting as many patients, as usual, to minimize exposure to COVID-19 during the second wave.

McClean Hospital / Harvard Medical School Belmont, Massachusetts remark on the need to explore the continuation of virtual PHP in the long-term concerning onboarding new staff (Hom et al., 2020). Historically new clinicians shadowed seasoned clinical staff (2020). New procedures developed to accommodate the training of new staff got instituted. Similar procedures are needed by having new clinical staff observe and eventually conducting groups with the observation by supervising the clinician.

BNBMC has been letting staff go due to decreased census since the pandemic’s first wave. Lockdowns have impacted canceled elective surgery, fewer emergency trauma hospitalizations, and some illnesses. When the pandemic is under control, the determination of the expansion of telepsychiatry continuing will influence expansion.

                                           Conclusion

The COVID-19 pandemics’ impact has been boundless in effect on healthcare (Rosen, 2020). Telepsychiatry’s future is in question despite the vital role of healthcare provision while protecting patients in need from exposure to COVID-19. Hopefully, the successes and future research studies will lead to expansion and a full embrace by the stakeholders as a valuable option providing greater latitude of care for those who would not otherwise have access.

References

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From ex-

pert clinician to influential leader (3rd ed.). New York, NY: Springer.

Chen, J. A., Chung, W. J., Young, S. K., Tuttle, M. C., Collins, M. B., Darghouth, S. L.,

Longley, R., Huffman, J. C., Razafsha, M., Kerner, J. C., Wozniak, J. & Huffman, J. C. (2020).

COVID-19 and telepsychiatry: Early outpatient experiences and implications for the future, 66, General Hospital Psychiatry. www.elsevier.com/locate/genhospsych.

Hom, M. A., Weiss, R. B., Millman Z. B., Christensen, K., Lewis, E. J., Cho, S., Yoon, N. A.,

Meyer, J. D., Shavit, E., Schrock, M. D., Levendusky, P. G. & Bjorgvinsson, T. Development of Virtual Partial Hospital Program for an Acute Psychiatric Population: Lessons Learned and Future Directions for Telepsychiatry, 30(2), Journal of Psychotherapy Integration. http://dx.doi.org/10.1037/int0000212

Rosen, L. A., Morland, L. A., Glassman, B. P., Weaver, M. K., Smith, C. A., Pollack, S. &

Schnurr, P. P. (2020). Virtual Mental Health Care in the Veterans Health Administration’s Immediate Response to Coronavirus Disease-19, American Psychologist, Online First Publication, American Psychological Association. http://dx.doi.org/10.1037/amp0000751

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