Review of ECT Practice at Riverview Hospital - ECT at Riverview Hospital

Written by Riverview Hospital Report

Recommendations: a) The ECT program at RV is in need of a database in order to gather statistics that will answer the questions regarding utilization of the practice of ECT. A year and a half delay is unacceptable and needs to be reassessed. b) An appropriate ECT outcome tool needs to be completed for each patient at the completion of the Index Course of ECT and then on an ongoing basis for those patients receiving Maintenance ECT. It should be included and easily identified in the patient chart.

c) Riverview needs to enhance and formalise an outpatient ECT clinic. This would involve an expansion of resources. A full-time ECT nurse coordinator could take on several roles including: i. Enhancing ECT education to patients, families and staff (e.g. managing groups) ii. Participating in planning for further education iii. Liasing with the community referral source for patient management iv. Maintaining outpatient ECT statistics.

Additional resources would also allow for additional ECT days (Tuesday and Thursday). This would reduce the total number of patients treated in one day and therefore reduce the waiting time for patients requiring who must fast prior to treatment.

Additional observations: While Riverview is filled with talented and caring professionals, it appears to struggle in the area of developing a healthy work culture.

In our review, we met with a wide variety of professionals including psychiatrists, nurses, anesthesiologists, general practitioners and administrators. Many described their interdisciplinary relationships with colleagues and other health care providers as thoroughly satisfactory. Others expressed fear that speaking out about controversial subjects leads to retribution by the administration in the form of termination of contracts or demotions.

These are serious allegations. They point to a culture which feels unwelcome of diverse opinions, which threatens people's sense of security, and which is strongly hierarchical. The involvement of the media and letters to the health minister may be reflections of this culture.

Riverview Hospital needs to foster an improved quality of internal communication and provide manifestation of respect for individuals' freedom of expression.

Concluding Remarks:

ECT delivery at Riverview Hospital is of high quality. Protocols and guidelines for safe and effective application are in effect. A Reasonable and acceptable informed consent process is in place which is in keeping with current legislation. There are some areas for improvement such as revising second opinion protocols, updating education for Riverview Staff, and expanding resources for outpatient ECT.

Although questions have arisen pertaining to ECT utilization, the lack of trust that such issues will be fairly addressed within the organization has caused this issue to become public. The staff, patients, and families of Riverview Hospital have experienced distress as a result of adverse publicity. There is a need for Riverview Hospital and other health care professionals to improve public understanding about ECT.

The number of ECTs at Riverview Hospital has increased. Data explaining this increase are currently unavailable and therefore conclusions regarding utilisation cannot be made at this time. A comprehensive Province-wide database, including appropriate outcome measures, is essential.

February 21, 2001 Riverview Report

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