February 21, 2001
Riverview Hospital Report

Carried out by:

* Dr. Caroline Gosselin (Head, Dept. of Geriatric Psychiatry, VHHSC) - Chair
* Dr. Elisabeth Drance (Geriatric Psychiatrist, Providence Health Care) - Member
* Ms. Jeanette Eyre (RN and ECT Coordinator, UBC Hospital) - Member
* Dr. Norman Wale (Anesthesiologist, Dept. of Anesthesia, Royal Jubilee Hospital, Capital Health Region) - Member
* Dr. Athanasios Zis (Professor and Head, Dept. of Psychiatry, UBC and VHHSC) -Member
* Mr. Noam Butterfield (PhD candidate, Pharmacology & Therapeutics, UBC) - Secretary and Principle Facilitator
* Mr. Wayne Jones (MHECCU, St. Paul's Hospital) - Statistical Consult

February 21, 2001

Review of ECT Practice at Riverview Hospital February 21, 2001

PURPOSE: The Ministry of Health, Division of Mental Health Services, has appointed a committee to review the current practice of electroconvulsive therapy (ECT) at Riverview Hospital (RVH). The mandate of this review was to determine if patients at RVH are provided with ECT services that are appropriate and safe, and to make Recommendations to improve ECT service.

COMMITTEE COMPOSITION: * Dr. Caroline Gosselin (Head, Dept. of Geriatric Psychiatry, VHHSC) - Chair
* Dr. Elisabeth Drance (Geriatric Psychiatrist, Providence Health Care) - Member
* Ms. Jeanette Eyre (RN and ECT Coordinator, UBC Hospital) - Member
* Dr. Norman Wale (Anesthesiologist, Dept. of Anesthesia, Royal Jubilee Hospital, Capital Health Region) - Member
* Dr. Athanasios Zis (Professor and Head, Dept. of Psychiatry, UBC and VHHSC) - Member

ADDITIONAL CONTRIBUTORS: * Mr. Noam Butterfield (PhD candidate, Pharmacology & Therapeutics, UBC) - Secretary and Principle Facilitator * Mr. Wayne Jones (MHECCU, St. Paul's Hospital) - Statistical Consult

TERMS OF REFERENCE (as outlined by the Ministry of Health): Purpose: To determine if patients at RVH are provided with ECT (electroconvulsive therapy) services that are appropriate and safe, and to make recommendations to improve service.

Issue: ECT practice at RVH has been questioned by Dr. Jaime Paredes, Medical Staff President, in a letter to Honourable Corky Evans, Minister of Health and Minister Responsible for Seniors. Media coverage reflects concern for safety of clients.

Deliverables: The review will determine practices for both in- and outpatient ECT in the following areas and compare with accepted medical practice:

1. Equipment of Physical Design - specifications of the ECT machine (e.g. waves, voltage, monitoring heart rate, e.e.g.s etc) design of the ECT and recovery rooms, safety and anesthetic and ancillary equipment issues.

2. ECT Technique and Anesthesia - issues of technical competence (unilateral versus bilateral; timing of current, wave forms, etc) that are designed to have the therapeutic effect and reduce memory disturbance. Medications including type and dosage of anesthetics used during ECT and physiological monitoring during ECT.

3. Care Plan and Documentation - protocols and guidelines in place for ECT. Clear documentation of Assessment and treatment plan.

4. Preparation and Aftercare - preparation of the patient for the procedure and aftercare including instructions to caregivers.

5. Patient Selection - exclusions for other medical conditions, characteristics of psychiatric conditions including non-responsiveness, urgency, etc. and indications for second opinions and other consultations are addressed. Indications for maintenance ECT.

6. Patient Education/Consent - process for informed consent; consent forms; completed methods of presenting material to patients and families.

7. Staff Training - level of skill and knowledge of staff involved in any aspect of providing ECT.

8. Monitoring and Evaluation - RVH practice of monitoring important aspects of ECT. Trends and comparisons in the use of inpatient and outpatient and maintenance ECT. Monitoring, on a periodic basis the type of equipment, techniques, staff training and patient outcomes.

NOTE: The review is to address system issues as opposed to professional practice of individuals. Individual practice concerns are not the purview of this report and, therefore the review team will refer such issues to appropriate RVH professional bodies and/or provincial practice bodies.

REVIEW PROCESS: Discussions were held over three days with management, medical staff, nursing staff, patients and their families and patient advocacy groups.