Study Response
Efficiency Study of the State Psychiatric Hospitals Findings and Recommendations
| Finding | Recommendation |
| The state psychiatric hospitals continue to treat significant numbers of substance abuse patients, even though the state has rescinded designation of psychiatric hospitals as substance abuse treatment centers. | Require Alcohol and Drug Abuse Treatment Centers and other community-based substance abuse treatment facilities that accept state funds to accept patients who are intoxicated, still actively using, and/or threaten violence to themselves or others. |
| Geriatric patients and patients suffering from Alzheimer’s and other dementia could receive more appropriate treatment in the community. | Develop a strategy in conjunction with area authorities, rest homes and nursing homes to close Geriatric Long Term and Nursing Facility units in state psychiatric hospitals and use community resources to care for these patients. |
| Children and adolescents could be better served in community-based facilities. | Develop a strategy in conjunction with area authorities to close Youth Units at the four hospitals and use community resources for these patients. |
| While state psychiatric hospitals are supposed serve patients equitably by region, Wake and Durham area authorities use the state hospitals at a greater rate than their populations would indicate. | The North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) should work closely with the Wake and Durham area authorities to reduce their state psychiatric hospital admissions to levels appropriate for their region’s populations. |
| The number of state psychiatric hospital beds for adults is not proportionate to the regions’ share of the state’s population. | Reduce the number of beds at Umstead and Cherry to reflect the proportion of the state’s populations living in the hospital’s service areas. |
| Some patients now in state psychiatric hospitals could receive more appropriate treatment at a lower cost in community-based programs. (Summarizes findings 1-5.) | Summarizes recommendations 1-5 regarding numbers of beds. |
| The hospitals’ building and ward configurations increase the number of direct care staff required, while the age and condition of facilities greatly affect total operating costs. The building layouts and physical condition make the hospitals inefficient to operate. | Build four state-of-the-art psychiatric hospital complexes, using Disproportionate Share Hospital (DSH) money to fund construction. |
| Contrary to the state’s philosophy of providing a single portal of entry into its mental health care system, North Carolina has two streams of funding for mental health services—one for state psychiatric hospitals and one for area authorities. | Create a single stream of funding for mental health services. |
| Mainstreaming patients with legal status into the general hospital population requires one-to-one direct care staffing whenever the legal status patient is off the unit. Mainstreaming and the resulting close supervision requirement adversely affect the hospital’s efficiency, safety and level of therapeutic activity. | Serve all legal status patients on the Forensic Treatment Unit at Dix Hospital. |
| The hospitals lack strong internal accounting controls. | Financial and accounting practices and procedures should be consistent across the four hospitals. Division and hospital managers should assure that each hospital uses common classification schemes for expenses and cost centers so that data contained in RCC and Medicaid cost reports can be compared by hospital Additionally, all professional clinical staff at all hospitals should collect and submit productivity data for management review. The Division should work with directors of the various professions at each hospital to define the data elements to be included in these reports so they are consistent for all hospitals. |
| The state psychiatric hospitals do not base direct care staffing patterns on an effective psychiatric acuity system. | Obtain and implement an acuity assessment system that measures patients’ psychiatric as well as medical needs. |
| Only one of the state psychiatric hospitals—Umstead—uses unit-centered nurse staffing. The lack of unit-centered staffing leads to inefficient and ineffective operations. | Institute unit-centered staffing at Broughton, Cherry and Dix hospitals. |
| Hospitals provide limited intensive therapeutic activity in many units. | Hospital administrators and staff should ensure that every unit provides the highest possible level of intensive therapeutic activities for its patients. |
| More patients are admitted to state psychiatric hospitals during the second and third shifts, yet hospital admission units have more staff assigned to the day shift. | The hospitals should reallocate their admissions unit staffing to provide more coverage for second and third shift to better match staffing needs. The medical staff should assign physicians and psychiatrists to shifts with a history of high admissions, such as weekend nights. |
| Significant direct care staff time is spent on non-patient care duties due to the limited availability of support staff. | Rearrange the work schedules of housekeeping staff so they cover seven days each week, at least two shifts per day. Examine other support staff schedules to determine how re-deployment of those staff would lead to better utilization of direct care staff. |
| Market competition is impairing the hospitals’ ability to attract and retain qualified health care staff. | The division should request the Office of State Personnel to conduct a market assessment of LPNs and HCTs. |
| The timekeeping system is highly manual, very time consuming and highly inefficient. | The division should obtain an automated timekeeping system for use in the state psychiatric hospitals. |
| The state psychiatric hospitals’ lack of automated systems and other technologies makes them inefficient and ineffective. | The state needs to provide funding to upgrade the hospitals’ computer systems, the maintenance work order system, personal protection and paging systems. |
| The hospitals should more vigorously pursue outsourcing opportunities, particularly in regard to the Medical/Surgical Units. at Dix and Broughton hospitals. | The study’s authors believe outsourcing of either or both of the Medical/Surgical Units merits additional investigation using the model developed by MGT and used to analyze other services. |
| State psychiatric hospitals expend more than a million dollars providing services to other public sector institutions. | Increase annual receipts for providing continuous in-sourcing services. |
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