2022 Stronger - PH325 - Multi-Faceted Management of Behavioral Concerns in a Non-Psychiatric ED and General Hospital - On Demand
In this 200-bed medical-surgical hospital without a dedicated inpatient psychiatric unit or psychiatric emergency department (ED), new patient arrivals needing mental health evaluations were admitted to the medical-surgical unit and seen by the Consult-Liaison Psychiatry (CLP) service. Hospital leadership recognized the significant demand for liaison work around staff responses to patient behavior (e.g., agitation and uncooperativeness), as well as an opportunity to streamline care and decrease non-medically necessary transfers between care areas. Following the trial of a 24-hour delay between the psychiatric evaluation and hospital admission, this new workflow was associated with a 60% decrease in nonmedical hospital admissions and a 50% decrease in length of stay for all patients visiting the ED for behavioral health concerns, independent of discharge destination. In addition, from 2019 to 2021 the CLP service evolved in depth and breadth. Specific initiatives included: (1) use of behavioral health rounding nurses; (2) needs-driven interdisciplinary behavioral rounding; (3) protocolized behavioral emergency responding; and (4) complex management planning for patients at demonstrated risk of disruptive behavior. Preliminary analyses show progressively decreasing restraint utilization alongside decreased overhead calls for behavioral emergencies.
- Healthcare Quality Professionals
- Other Healthcare Professionals
Describe variations on traditional face-to-face psychiatric consultation-liaison to improve care management in a nonpsychiatric general hospital.
Discuss delayed admission workflow for patients presenting to the general emergency department with behavioral health needs.
Erin Howard, PhD, Assistant Professor, Department of Psychiatry and Behavioral Sciences, Duke School of Medicine, Duke Raleigh Hospital, Raleigh, NC
Elizabeth Larson, MSN, RN, Service Line Director, Neurosciences and Behavioral Health, Duke Raleigh Hospital, Raleigh, NC
Katia S. Ferguson, MSN, RN, CEN, NEA-BC, Clinical Operations Director, Duke Raleigh Hospital, Raleigh, NC
Vizient, Inc. designates this enduring material for a maximum of 0.50 ANCC contacts hours.
Healthcare Quality Professionals (CPHQ)
This activity is approved by NAHQ® for 0.50 CPHQ CE credits.
Other Healthcare Professionals (General CE Credit)
Vizient, Inc. will award a maximum of 0.50 contact hours to all other healthcare professionals who successfully complete the activity. These individuals will receive a Certificate of Participation indicating the maximum credits available.
Many state licensing boards and credentialing bodies accept certificates of participation from accredited CE activities to meet CE requirements for license renewals and re-certification. It is the responsibility of the participant to contact their state licensing board and/or certifying body for verification on credit eligibility reciprocity.
- 0.50 ANCC
- 0.50 CPHQ – Certified Professional Healthcare Quality
- 0.50 General CE – Attendance