Revamping the Day Hospital Program at North York General Hospital in response to COVID-related changes in patient demographics

Background The Dynamic Sustainability Framework emphasizes the need for improving programs after implementation in response to the evolving environment. This report illustrates said framework and describes significant changes made to the Psychiatric Day Hospital (DH) at North York General Hospital (NYGH) in response to pandemic-related changes in participant demographic. Patient and staff satisfaction pre- and post- program modification are compared. Problem The COVID-19 pandemic resulted in increased DH referral acuity and patient affect dysregulation. The program needed to adapt to these changes and better serve the new DH patient population. Methods DH participants and team member feedback was gathered. Five major areas of improvement were identified. Changes were systematically introduced from July 2021 to January 2022. Feedback post-implementation in 2022- 2023 from patients and DH team members were gathered for comparison. Interventions Dialectical Behavioral Therapy (DBT) was adopted as the theoretical basis of the revamped Day Hospital Program. All Day Hospital staff underwent training in DBT skills, with the creation of new treatment schedules and materials. Two separate streams were created for differing patient illness severity. The program continued to run during implementation of new changes, without disruption to the existing clinical workload. Results The program transitioned from a 3-week psychoeducational and rudimentary CBT program to a dual-stream 4-week DBT-based program to address patient acuity and higher prevalence of emotional dysregulation. Quantitative and qualitative feedback from new program participants have been positive. Conclusions The Day Hospital Program at NYGH made a successful transition in response to an evolving healthcare landscape. KEY WORDS: Mental Health/Psychiatry, Dynamic Sustainability, Program Improvement, Implementation Science