47 Year Old (YO) white female “Jane DOE” dx w/ Paranoid Schizophrenia lived most of her adult life in and out to mental health institutions. She was discharged from an institution at 46 YO to live independently in her own apartment in a NW metropolitan area that involved two different emergency response unit’s protocols.
Jane was enrolled in Mental Health outpatient services located 12 miles from her home, but demographically near local hospitals, Mental Health resources, her Case Manager, crisis beds and other state services. Jane had increased paranoid disruptive Mental Health behaviors that required her to see her Case Manager and psychiatrist weekly for medication management services. Because of Jane’s mental health situation sometimes she was not compliant with medication management, so she called the outpatient MH Case Manager and 911 several times up to 10 times in a 15-minute period. She would also come to the mental health clinic to see the nurse for medication, stating she didn’t remember if she had medication and therefore the nurse would give her a week’s supply of meds. Often, Jane would be admitted in the hospital for the weekend due to increase paranoia or danger to self.
Due to lack of interoperability between EHR systems the nurse would call the Emergency Room to confirm admission. If notes were captured, the ED would fax over the information – dependent on whether Jane gave HIPAA consent. If she was too paranoid during that episode, she would refuse to give consent, cause more disruption, and then refuse meds.
Jane’s next visit was to her outpatient psychiatrist: A Case Manager brings her in, she is pacing and paranoid stating she called 911 only 5 times this weekend and went to the local hospital for medication. Psychiatric services were not informed by either 911 or the hospital and had no EHR record showing possible medication change or crisis intervention. Later the insurance company reported that Jane utilized the ER at several hospitals in one county over 67 times in less than 90 days, she also utilized Emergency Services over 80 times in 60 days, plus she called 911 daily and by protocol they must go to her appt. This utilization information was NEW news to the Outpatient clinic. Because of the utilization rates a county high utilizer team was convened to review her case.