Pilot Projects

Bridge to Discharge Pilot Study

The Bridge to Discharge project was designed to assist with the discharge and community integration of people diagnosed with schizophrenia. The project involved a formal partnership between a psychiatric hospital unit (Schizophrenia Intensive treatment Unit of Hamilton Psychiatric Hospital), a public heath team (Community Mental Health Promotion Program of the Hamilton-Wentworth Department of Public Health Services), and a consumer group (Mental Heath Rights Collation). The in-patient unit specialized in the care of long-term clients who had generally been hospitalized a minimum of five years. The average length of stay on the unit was 5.8 years (range 0.5 to 27). In meetings prior to the initiation of the project, clients who were hospitalized described the hospital as both home and family; leaving the hospital was impeded by the fear of losing their hospital family. To help overcome this fear, two primary interventions were developed for the project - overlapping services and peer support.

Overlapping services meant that a community nurse and an inpatient nurse were involved with the client from the initiation of discharge planning until both nurses and client reached a consensus that the therapeutic relationship with the community nurse was well established. The length of overlap varied from client to client, but on average it took about a year to establish the relationship. Overlapping services also meant that the client could phone or visit the inpatient unit any time after discharge.

Peer support consisted of weekly inpatient visits from a discharged mental health client, a weekly community drop-in, a weekly community collaborative skills development opportunity (e.g. grocery, shopping, cooking, banking) and a monthly, community-based party available o all inpatients and community clients involved in the project.

The quantitative evaluation included improvement in quality of life and an economic analysis. During the initial 18-month pilot period, 14 clients were successfully 'bridged' from hospital to community. Nine of these were discharged during the 12-month fiscal year used for the economic analysis. The focus of the economic evaluation was the overall cost to the taxpayer. We compared the cost of the intensive community work to the cost of continued hospitalization. The total community cost of an individual's care ranged from $3155.79 to $40,410.85. The hospital's costs for treating an inpatient in the schizophrenia program were $347.32 per day (including direct treatment costs and hospital overhead). Additionally, hospital inpatients received $3.73 per day (or $112 per month) of government "comfort allowance". Over 12 months, the total savings of community care for nine clients, as compared to hospitalization, was an incredible CDN$496,862.55.

The MacDonald, Sibbald and Hoare Satisfaction with Life (SWL) questionnaire was administered to evaluate quality of life. All competent clients in the schizophrenia program were asked to complete the questionnaire during an interview. Using ANOVA, results from the client questionnaire indicated the overall improvement in quality of life to be statistically significant (p>0.003). The quality of life of the clients on the unit improved, whether or not they were formally involved in the project. Although the Bridge to Discharge clients had slightly higher scores on all but one subscale, the differences between the groups of clients were not statistically significant. Statistically significant improvements were noted in the following subscaled for all clients over time: restrictiveness in actions, lack of independence, isolation and lack of satisfactory surroundings. Improvements were not statistically significant in clients' perceptions of fear, unsatisfactory hygiene facilities, lack of status and recognition, and lack of autonomy.

The results of our Bridge to Discharge project were enormously encouraging. Through two primary interventions - overlapping services and peer support - our project not only saved taxpayers a great amount of money but, more importantly, improved the quality of our clients' lives.

Transitional Discharge Model Pilot Study (Scotland)

The Bridge to Discharge pilot findings were positive, however there was no comparison group and no randomization. The client population was not typical since the length of hospital say had been so prolonged. The Bridge to Discharge pilot study was replicated in acute admissions wards in Scotland. Clients from three acute admission wards were randomized on the day of discharge to either TDM or usual follow-up care. The TDM was offered by a group of transitional nurses and trained peer volunteers. Fewer symptoms, fewer re-admissions and better functioning were noted among clients randomized to the TDM group.

Publications:

Forchuk, C., Chan, L., Schofield, R., Martin, M. L., Sircelj, V. W., Jewell, J., Valledor, T. and Overby, B. (1998). Bridging the Discharge Process. The Canadian Nurse, 94(3): 22-26.

Forchuk, C., Jewell, J., Schofield, R., Sircelj, M. and Valledor, T. (1998). From Hospital to Community: Bridging Therapeutic Relationships. Journal of Psychiatric and Mental Health Nursing, 5: 197 - 202.

Forchuk, C., Schofield, R., Martin, M. L., Sircelj, M., Woodcox, V., Chan, L., Jewell, J., Valledor, T. and Overby, B. (1998). Bridging the Discharge Process: Staff and Client Experiences Over Time. Journal of the American Psychiatric Nurses Association, 4(4): 128-133.

Reynold W., Lauder W., Sharkey S., Macivier S., Veitch T. & Cameron D.  (2004).  The effect of transitional discharge model for psychiatric patients.  Journal of Psychiatric and Mental Health Nursing, 11, 82-88.

Schofield, R., Valledor, T., Sircelj, M., Forchuk, C., Jewell, J. and Woodcox, V. (1997). Evaluation of Bridging Institution and Housing - A Joint Consumer-Care Provider Initiative. Journal of Psychosocial Nursing, 35(10): 9-14.