2.50
Hdl Handle:
http://hdl.handle.net/10755/198364
Title:
Improving Surveillance of Psychiatric Patients in the Emergency Department
Abstract:
[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Improving Surveillance of Psychiatric Patients in the Emergency Department

Purpose: Continual surveillance of psychiatry patients in the Emergency Department (ED) have historically been carried out by Security Guards. Although Security Guards are able to insure the safety of assigned patients, their skill set is not optimal for de-escalation and therapeutic intervention.

Design: In order to implement the change, we initiated a quality based staff development project. Collaboration between the Emergency, Security and Psychiatry Departments was essential. This nursing driven initiative specifically included Physicians, Nurses and Ancillary Staff.

Setting: An urban academic Level I trauma center that treats an average of 84,000 patients per year.

Participants/Subjects: Patients presenting to the ED with suicidal or homicidal ideation. Additionally patients in acute psychiatric crisis who are unable or unwilling to cooperate with care.

Methods: An initial process flow map was completed to understand the pathway of care of psychiatry patients who present to the ED. This was completed to realize the average length of stay. Collaboration between the ED and Psychiatry Departments uncovered necessary changes in flow to insure a patient centered model of care. ED and Psychiatry Nurses designed and implemented training for the ED Assistants to improve their knowledge and skill regarding the care of psychiatric patients. Each staff member was then tested on their knowledge to reflect their level of understanding, their specific needs of the patient and operational changes within the department.

Results/Outcomes: Since the first of November when we opened the ED Psychiatry Milieu, we have tracked our data reflective of length of stay, the number of adverse events involving psychiatric patient population, the number of patients needing restraints, and patient satisfaction. The Psychiatric Patient of length of stay decreased by 37 minutes on average. The of adverse events in the Emergency Department involving Psychiatric Patients went from 3 to 0 when compared month over month. The number of Psychiatric Patients needing retraints fell 26% by the end of the first quarter of our fiscal year. Overall Patient Satisfaction improved by 10 percentage points within the 1st quarter of the fiscal year. The ED psychiatry milieu has enabled our staff to implement the patient centered model of care by improving focus on the psychiatric patient and their individualized needs.

Implications: Psychiatric patients who present to the ED for acute treatment require skilled care providers who are specifically trained to insure safety, timely de-escalation and rapid intervention through the partnership among the Psychiatry and Emergency Departments. By replacing security guards with skilled care providers we have demonstrated care improvements to insure this commitment. We strongly recommend, based upon the improvements made in both operational and patient satisfaction metrics, that ED assistants specifically trained in the care of acute psychiatric patients enhance the patient experience and improves outcomes.





Repository Posting Date:
21-Dec-2011
Date of Publication:
21-Dec-2011

Full metadata record

DC FieldValue Language
dc.titleImproving Surveillance of Psychiatric Patients in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/198364-
dc.description.abstract[ENA Annual Conference 2011 - Evidence-based Practice Presentation] Improving Surveillance of Psychiatric Patients in the Emergency Department<br/><br/>Purpose: Continual surveillance of psychiatry patients in the Emergency Department (ED) have historically been carried out by Security Guards. Although Security Guards are able to insure the safety of assigned patients, their skill set is not optimal for de-escalation and therapeutic intervention.<br/><br/>Design: In order to implement the change, we initiated a quality based staff development project. Collaboration between the Emergency, Security and Psychiatry Departments was essential. This nursing driven initiative specifically included Physicians, Nurses and Ancillary Staff. <br/><br/>Setting: An urban academic Level I trauma center that treats an average of 84,000 patients per year.<br/><br/>Participants/Subjects: Patients presenting to the ED with suicidal or homicidal ideation. Additionally patients in acute psychiatric crisis who are unable or unwilling to cooperate with care. <br/><br/>Methods: An initial process flow map was completed to understand the pathway of care of psychiatry patients who present to the ED. This was completed to realize the average length of stay. Collaboration between the ED and Psychiatry Departments uncovered necessary changes in flow to insure a patient centered model of care. ED and Psychiatry Nurses designed and implemented training for the ED Assistants to improve their knowledge and skill regarding the care of psychiatric patients. Each staff member was then tested on their knowledge to reflect their level of understanding, their specific needs of the patient and operational changes within the department. <br/><br/>Results/Outcomes: Since the first of November when we opened the ED Psychiatry Milieu, we have tracked our data reflective of length of stay, the number of adverse events involving psychiatric patient population, the number of patients needing restraints, and patient satisfaction. The Psychiatric Patient of length of stay decreased by 37 minutes on average. The of adverse events in the Emergency Department involving Psychiatric Patients went from 3 to 0 when compared month over month. The number of Psychiatric Patients needing retraints fell 26% by the end of the first quarter of our fiscal year. Overall Patient Satisfaction improved by 10 percentage points within the 1st quarter of the fiscal year. The ED psychiatry milieu has enabled our staff to implement the patient centered model of care by improving focus on the psychiatric patient and their individualized needs. <br/><br/>Implications: Psychiatric patients who present to the ED for acute treatment require skilled care providers who are specifically trained to insure safety, timely de-escalation and rapid intervention through the partnership among the Psychiatry and Emergency Departments. By replacing security guards with skilled care providers we have demonstrated care improvements to insure this commitment. We strongly recommend, based upon the improvements made in both operational and patient satisfaction metrics, that ED assistants specifically trained in the care of acute psychiatric patients enhance the patient experience and improves outcomes. <br/><br/><br/><br/><br/><br/>en_GB
dc.date.available2011-12-21T12:47:37Z-
dc.date.issued2011-12-21T12:47:37Z-
dc.date.accessioned2011-12-21T12:47:37Z-
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