PAM Behavioral Health Workflow
Cura behavioral health services focus on the connection between the health and well-being of the body and the mind. Post Acute Medical’s mission to be the most trusted source for post acute care in the nation has prompted the implementation of behavioral health services. As such Post Acute Medical has retained full access to behavioral health professionals of psychiatrists and psych certified NPs.
During this 2 month pilot phase we will evaluate the needs of behavioral health services in the Post Acute Medical Facilities in Texas and Nevada. We will utilize existing iPads within the organization that will rest on stands for patients interaction during the consultation services.
Many patients struggle with issues involving behavioral health, this is particularly notable in the post acute period. Unfortunately many mental health challenges aren’t getting the treatment required or the necessary resources are not available. In the post acute setting the incidence of behavioral health issues are as high as 45%. It is critical to understand the impact of these issues on the patient’s overall wellbeing, ability to wean from chronic treatments, participate in therapy and overall improvement.
Sixty-eight percent of adults with mental health disorders also struggle with medical conditions. Some of these conditions are chronic, and the cost of managing these conditions is high. The cost of managing the physical health of a patient with an underlying behavioral issue is estimated to be three times more than that of a patient without these challenges. These issues will follow the patient from the post acute setting to home, slowing recovery, if not managed properly.
Existing iPads will allow for the method of video visits. Over the next 2 weeks we will have training available and the behavioral health navigator will receive your calls and guide you through the process at any time needed. Please look for a training video, additional brochures, and a calendy schedule to schedule during available training blocks. Our goal is to have 2-3 people per site able to log in, create consultation requests and print the received consultation clinical documents.
It is important to keep in mind many underlying mental health conditions may exist that are identified with established screening tools.
As part of a comprehensive behavioral health service each patient will undergo screening with PHQ-9 and GAD-6. Selective screening may take place using the mood assessment, insomnia and sleep assessments, CAGE, and Opioid Risk tool. These assessment tools are provided as part of the Cura Behavioral health triage.
If the PHQ-9 is medium (10-14 pts) or high (15-27) points or the GAD-6 is medium (10-14) or high (15-21) a BH consultation is indicated. BH consultation is also indicated in settings of alcohol or substance abuse, opioid addiction, disruptive ADHD, mood disorders such as bipolar, and schizophrenia.
Delirium is often associated with a sleep disturbance in the post acute setting and is often best suited with behavioral health consultation.
Dementia, Parkinsonism, and Seizures could consult with Neurology or psychiatry depending on the clinical need.
The general workflow from a computer workstation or iPad will include:
Log in to the Cura web page or app. The web page is app.cura.com
You can find your user name or reset password from any web browser.
Create the patient.
Enter the basic information of name, sex, and date of birth, create account. Skip granting the patient a user name or password at this point. Written consent of the patient or POA for telemedicine services is obtained at intake.
Under the patient chart select “request consult” Provide a brief description of the reason for consult. Skip forward, enter allergies if any or none, select video visit, specialist, then psychiatry. Select any provider available and time desired then select submit consult.
The provider will receive a page notification for the consult. They will call within 15 minutes of the set time. If they need to change the time they will suggest an alternate time by in app message or call the floor.
Alternatively call or text the Cura OneCall number at 888-910-2872 ext 705. An attendant will answer 24/7. Please provide the facility name, patient name, DOB, and reason for consult (e.g. depression, parkinsons), and desired date/time of consult. This still requires the patient account creation and document uploads as below.
The provider will then make a direct call to the device at your facility. If the app is open in the background or logged in the device will ring like a telephone. Simply answer and the video session will start.
Upload Needed Documents
Each patient needing consultation will need the face sheet, MAR, History and Physical, most recent progress note, pertinent labs (Na, ammonia level, Valproate levels), and imaging results loaded into Cura. These documents can be scanned together as one file in the Kodiak scanner downloaded from your email then uploaded to the patient chart under uploads > lab results and documents.
After answering the video visit please present the provider to the patient and state the patient’s name. The provider will also ask for the date of birth to confirm two patient identifiers. You may then stay with the patient or leave depending on the provider request and your other needs.
At the end of the video session the provider will review with the nurse, patient and family the treatment plan. At this time the provider will also recommend if further follow up is required. The provider will enter the note which should be available relatively immediately but no longer than 24 hours in the Cura platform.
At the time of discharge we will follow up with the patient to ensure they have outpatient behavioral health services arranged. If they do not have an established provider we will make Cura Behavioral Health services available to them.