Abstract
Poster presentation
Session E presented Tuesday, October 1, 10:00-11:00 am
Purpose: Our facility sees an average of over 200 mental health patients every month, with limited community resources. The length of stay (LOS) for these patients had slowly risen to unacceptable levels; the number of patients whose LOS was greater than 24 hours increased by 81% in 2017, from 633 patients to 1145. Patients in crisis require expedited transfer to appropriate care locations. Our goal was to decrease the overall LOS for mental health patients in the Emergency Department.
Design: This was a clinical quality improvement project.
Setting: A Level One Trauma Center, with academic affiliation.
Participants/Subjects: All ED staff including ED Social Work and Psychiatry participated in this project.
Methods: LOS is measured as time of arrival to the Emergency Department until time of final disposition; discharge, admission or transfer. Interventions include the development of daily interdisciplinary rounds on mental health patients, a standardized intake process for mental health patients in crisis, diagnosis based protocol development, staff communication tools for long stay mental health patients, daily bed management calls with emergency departments, local hospitals, mental health facilities, and community mental health resources to discuss placement planning and priorities, participation in the IHI Initiative, Integrating Behavioral Health in the Emergency Department and Upstream (ED & Up) Learning community, and development of relationships with community resources to support discharged patients.
Results/Outcomes: While the volume of mental health patients showed a steady increase from 2017 through 2018, we were able to substantially decrease the number of patients whose LOS was greater than 24 hours. The first fiscal quarter of 2019 saw a 46% decrease. In patients whose LOS was greater than 48 hours, the decrease was even more impressive at 57%. The interventions enabled us to increase the quality and timeliness of care delivered and transition these patients to the most appropriate care environment.
Implications: Across the country Emergency Departments are seeing an increase in the number of mental health patients and longer boarding times, with some patients waiting days for an inpatient bed. Boarding of these patients has shown to increase morbidity and mortality and contribute to the stress of staff. It is in the best interest of the patient to prevent further mental or emotional deterioration and to transition them to the most appropriate environment to address their care needs.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
Mental Health, Boarding, Length of Stay
Recommended Citation
Collins, Faye and Goudey, Nancijean, "Reducing length of stay for mental health patients" (2020). General Submissions: Presenations (Oral and Poster). 121.
https://www.sigmarepository.org/gen_sub_presentations/2019/posters/121
Conference Name
Emergency Nursing 2019
Conference Host
Emergency Nurses Association
Conference Location
Austin, Texas, USA
Conference Year
2019
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Reducing length of stay for mental health patients
Austin, Texas, USA
Poster presentation
Session E presented Tuesday, October 1, 10:00-11:00 am
Purpose: Our facility sees an average of over 200 mental health patients every month, with limited community resources. The length of stay (LOS) for these patients had slowly risen to unacceptable levels; the number of patients whose LOS was greater than 24 hours increased by 81% in 2017, from 633 patients to 1145. Patients in crisis require expedited transfer to appropriate care locations. Our goal was to decrease the overall LOS for mental health patients in the Emergency Department.
Design: This was a clinical quality improvement project.
Setting: A Level One Trauma Center, with academic affiliation.
Participants/Subjects: All ED staff including ED Social Work and Psychiatry participated in this project.
Methods: LOS is measured as time of arrival to the Emergency Department until time of final disposition; discharge, admission or transfer. Interventions include the development of daily interdisciplinary rounds on mental health patients, a standardized intake process for mental health patients in crisis, diagnosis based protocol development, staff communication tools for long stay mental health patients, daily bed management calls with emergency departments, local hospitals, mental health facilities, and community mental health resources to discuss placement planning and priorities, participation in the IHI Initiative, Integrating Behavioral Health in the Emergency Department and Upstream (ED & Up) Learning community, and development of relationships with community resources to support discharged patients.
Results/Outcomes: While the volume of mental health patients showed a steady increase from 2017 through 2018, we were able to substantially decrease the number of patients whose LOS was greater than 24 hours. The first fiscal quarter of 2019 saw a 46% decrease. In patients whose LOS was greater than 48 hours, the decrease was even more impressive at 57%. The interventions enabled us to increase the quality and timeliness of care delivered and transition these patients to the most appropriate care environment.
Implications: Across the country Emergency Departments are seeing an increase in the number of mental health patients and longer boarding times, with some patients waiting days for an inpatient bed. Boarding of these patients has shown to increase morbidity and mortality and contribute to the stress of staff. It is in the best interest of the patient to prevent further mental or emotional deterioration and to transition them to the most appropriate environment to address their care needs.