Improving Transition Planning in Adolescent Psychiatric Care to Enhance Mental Health Outcomes

Background: The purpose of this quality improvement project was to evaluate the current transition planning process in an adolescent psychiatric day treatment program in Utah and develop recommendations to improve transitions to outpatient care. Adolescents experience mental health disorders and receive psychiatric care in a variety of settings. A significant portion of patients discharged from acute psychiatric care receive delayed psychiatric services that negatively impact mental health outcomes. Patients who do not attend follow up appointments within 30 days of discharge experience higher rates of rehospitalization and suicide. Purpose: The Meleis Transition Theory provided a framework to evaluate the organizational transitions in a psychiatric setting. It was hypothesized that a portion of patients experienced disrupted transitions to continued outpatient care and were at risk for increased psychiatric acuity. It was anticipated that evaluating the transition process in the organization and educating staff regarding this would provide data that could be used to inform recommendations for an improved transition process. While transitions to outpatient care have been identified as important to mental health outcomes, existing literature does not define clearly identified transition recommendations from day treatment to outpatient care. Methods: A retrospective chart review was conducted to assess the process of transition planning and post-discharge 30-day follow up appointment attendance. Staff with roles in transitions in the organization participated in an educational presentation regarding the current transition process and answered open-ended questions addressing facilitators and barriers to effective transitions. This data was used to develop recommendations for an improved transition process. This included identifying a more specific transition process with clearly defined multidisciplinary treatment team roles, improved team communication, and education. Results: Approximately one third of transitions from the organization to outpatient care are vague or incomplete. At least 15% of patients evaluated over a six-month period did not attend a 30 day follow up appointment after discharge. Staff identified that developing a more clearly defined transition process that includes improved communication and education would improve the overall transition process in the organization. Data gathered from the retrospective chart review and open-ended questions were used to develop recommendations for an improved transition process that would improve mental health outcomes. Discussion: This project demonstrated incomplete transition planning and aftercare are present in this setting. A poorly defined transition process without clearly defined steps and resources for staff contributes to disrupted aftercare. Incorporating staff feedback regarding transitions improves transition planning. Further research is needed to evaluate the impact of an improved transition process on day treatment psychiatric transitions, including improved completeness of discharge planning and increased rates of 30-day appointment attendance following discharge.