Lawson launches new discharge model for mental health clients moving from hospital to community

April 12, 2013

Lawson Health Research Institute rolls out an innovative new Ontario-wide approach for discharging mental health clients from hospitals. Led by Lawson’s Dr. Cheryl Forchuk, nine hospitals are participating in the four-day training program, funded by the Council of Academic Hospitals of Ontario’s (CAHO) Adopting Research to Improve Care (ARTIC) Program.
The transition from hospital to community is complex and can be challenging for people who have been diagnosed with a mental illness. Research shows the first days and weeks following psychiatric discharge are particularly high-risk periods for relapse. As many clients are between care providers, they are vulnerable to emergency room visits and readmission to hospital. Forty-three per cent of suicides occur within the first month post-discharge.
The Transitional Discharge Model (TDM) is designed to provide seamless support as clients make this transition. The TDM ensures hospital staff continue to provide care until the client is connected with a community care provider. It also partners discharged clients with a peer has successfully integrated into the community after a psychiatric diagnosis.
Previously, Dr. Forchuk and colleagues implemented this project in 13 wards at four regional hospitals while a matched 13 wards provided usual care. Results showed the length of stay was reduced by an average of 116 days per client. This amounts to over $12 million worth of freed bedspace, and $4,400 less hospital and emergency room services per person in the year after discharge.
As they roll the TDM out province-wide, Dr. Forchuk and her team hope to continue to improve patient outcomes and reduce the strain on hospital resources, while strengthening the working relationships between hospitals and community support groups.
“Our government is committed to building a patient-centred, evidence-based health care system that gets better value for taxpayer dollars,” says Hon. Deb Matthews, Deputy Premier and Minister of Health and Long-Term Care. “ Projects like the Transitional Discharge Model show how relatively low-cost research innovations can have a high impact by sharing and implementing evidence that improves the quality of patient care."
"We can increase the quality and efficiency of care dramatically for people with mental illness by using evidence-based approaches to collaboration and coordination between hospitals and community supports," Dr. Forchuk says. "We are looking forward to working with the CAHO ARTIC Program as it will accelerate the implementation of TDM across several hospitals, increasing efficiency and improving the care we provide."
"The CAHO Adopting Research to Improve Care (ARTIC) Program is helping to construct Ontario's evidence implementation pathway,” says Karen Michell, Executive Director of CAHO.“ Ontario's research hospitals are working collaboratively to bring high impact evidence from one member institution to improve the quality of care across all of our member hospitals. The TDM is a great example of how evidence can improve the quality and productivity of the mental health care delivery."
“The TDM ARTIC Project will enable the dissemination of knowledge across and link together
hospitals to community-based peer support groups,” says Deborrah Sherman, Executive Director of the Ontario Peer Development Initiative (OPDI). “This coordination as the client transitions from the hospital to community will ensure continued support and reduce the chance of a return trip to the hospital.”
Nine hospitals are participating in the program: Baycrest (Toronto), Centre for Addiction and Mental Health (Toronto), Hôpital Montfort (Ottawa), London Health Sciences Centre (London), Ontario Shores Centre for Mental Health Sciences (Whitby), Providence Care (Kingston), St. Joseph’s Healthcare Hamilton (Hamilton), St. Joseph’s Health Care London (London) and Thunder Bay Regional Health Sciences Centre (Thunder Bay).
The project is funded by a $1.5 million grant through the CAHO ARTIC Program. The goal of the program is to support the successful and rapid adoption of innovation into the practice of health care. It supports projects like the TDM to improve coordination and continuity of health care for patients/clients in transition, to reduce hospital stays and readmission rates, while improving quality of care.

Dr. Cheryl Forchuk, Assistant Director at Lawson and lead researcher on the TDM Project; Deborrah Sherman, Executive Director, Ontario Peer Development Initaitve (OPDI); Dr. David Hill, Scientific Director, Lawson; Karen Michell, Executive Director, CAHO.