یک رویکرد شبیه سازی رویداد گسسته در مورد برنامه ریزی برای خدمات سلامت روان
1- Introduction
2- Methods
3- Results
4- Discussion
5- Conclusion
References
Introduction
The rising number of emergency department (ED) visits in Ontario, Canada, is currently outpacing the population growth [1]. In seven years, the number of ED visits increased by 13.4% (from 5.2 million in 2008 to 5.9 million in 2014), while in the same period, the province’s population only experienced a 6.2% growth [1]. According to Health Quality Ontario, visits to the ED are expected to rise even further, given that the population size in Ontario is estimated to grow by 30% in the next 25 years [1]. Additionally, there has also been an increase in ED visits related to mental health and addiction (MHA) in Ontario [2–8]. In particular, the number of MHA visits paid to the ED of Toronto Western Hospital (TWH), an academic hospital in Toronto, Ontario, increased by 55.7% in the last five years (2012–2016), compared to 14.5% for nonmental health and addiction (NMHA) visits. MHA visits account for 9.3% of all ED visits at TWH [5]. *ere is also evidence that ED visits for MHA have longer length of stay (LOS) compared to NMHA visits [5, 9, 10]. In response to prolonged wait times experienced in EDs and the impact of MHA on hospital use [11], there are system efforts underway to explore ways to improve the experience and impact of MHA ED visits. Several hospitals in the Greater Toronto Area have created separate MHA emergency units (usually within the ED) to provide streamlined care and safer environments for patients [12– 15]. Another Ontario program to reduce the number of MHA ED visits is the META : PHI (Mentoring, Education, and Clinical Tools for Addiction : Primary Care-Hospital Integration), which provides evidence-based and timely treatment for patients with alcohol and opioid-related conditions through the use of Rapid Access Addiction Medicine (RAAM) clinics [16, 17]. Under the META : PHI care pathway, upon discharge from the ED, patients with alcohol and opioid-related dependence are referred to a RAAM clinic where they are seen by an addiction specialist within one week from their discharge date [18], thus contributing to a reduction in the number of addiction-related visits to the ED [19, 20]. At Health Sciences North in Sudbury, when comparing the number of times patients visited the ED 90 days before and after their first RAAM appointment, a 63% reduction in the number of ED visits was observed [19]. Similarly, in Sarnia, a 45% reduction has been reported [20]. As of July 2018, 29 RAAM clinics in 19 cities are listed on META : PHI’s website (8 of which are located in Toronto) [21].