Dr. Giuseppe Guaiana says a new consultation system has energized staff at his mental health unit
Running a practice means continually looking for improvements that benefit patients, staff and physicians.
To help spread the word about good ideas, we’re asking Ontario doctors to share one operational change that has meaningfully improved their day-to-day work.
This week, we speak to Dr. Giuseppe Guaiana, chief of psychiatry and medical director of the mental health unit at St. Thomas-Elgin General Hospital in St. Thomas, Ont.
Dr. Guaiana shares how implementing a triage and telephone consultation system at his hospital greatly improved workflow.
“We stopped asking, 'How can we make sure everybody sees a psychiatrist in person?' and started asking, 'Does everybody need to see a psychiatrist in person?'”
Introducing a triage and telephone consultation system in our outpatient program has made a difference in the flow of patients from the community to our psychiatrists and counsellors.
We dedicated a social worker specifically to triage. If there’s any uncertainty, they consult with me and I determine how we proceed.
For lower-risk cases, a psychiatrist has a brief call, usually about 10 minutes, with the patient’s family physician. Then we'll make a determination. In most cases, we provide some recommendations.
If we think the case may be really severe, we schedule an in-person assessment.
At one point, we had about 160 to 170 patients waiting to see a psychiatrist and a wait time of about 10 months.
Family physicians also wanted some way to connect with our psychiatrists over the phone. From 2014 to 2024, before we implemented this new system, we very rarely did telephone consultations.
So we stopped asking, “How can we make sure everybody sees a psychiatrist in person?” and started asking, “Does everybody need to see a psychiatrist in person?”
“We were feeling overwhelmed and felt there was too much demand and too little supply of services.”
The wait time is now four to six weeks, so people are seen pretty quickly. And our team is more energetic. Before, we were feeling overwhelmed and felt there was too much demand and too little supply of services.
It’s had a much better impact on our morale because we feel we’re more effective. We published a scientific article about our results.
It hasn’t been seamless. Some family physicians have been in agreement, but others felt this system had been imposed on them. Some have either flat-out refused or were begrudgingly doing it.
So that's been difficult and it's an ongoing conversation. I meet with them on a regular basis to hear their concerns.
We had to make a difficult decision between different outcomes and we chose the most patient-centred option.
First, reach out to peers who may have had the same experience. And second, do not be afraid of it being unpopular at first. Sometimes, to implement changes, you have to be unpopular. There are no solutions without trade-offs.
And try to be really clear on the objective. Explain why you're implementing the change. What's the benefit?