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Use of a Dedicated, Non–Physician‐led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay
Author(s) -
Uspal Neil G.,
Rutman Lori E.,
Kodish Ian,
Moore Ann,
Migita Russell T.
Publication year - 2016
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12908
Subject(s) - medicine , emergency department , psychological intervention , mental health , multidisciplinary team , emergency medicine , quality management , patient satisfaction , medical emergency , psychiatry , nursing , management system , management , economics
Objectives Utilization of emergency departments ( ED s) for pediatric mental health ( MH ) complaints is increasing. These patients require more resources and have higher admission rates than those with nonpsychiatric complaints. Methods A multistage, multidisciplinary process to reduce length of stay ( LOS ) and improve the quality of care for patients with psychiatric complaints was performed at a tertiary care children's hospital's ED using Lean methodology. This process resulted in the implementation of a dedicated MH team, led by either a social worker or a psychiatric nurse, to evaluate patients, facilitate admissions, and arrange discharge planning. We conducted a retrospective, before‐and‐after study analyzing data 1 year before through 1 year after new process implementation (March 28, 2011). Our primary outcome was mean ED LOS . Results After process implementation there was a statistically significant decrease in mean ED LOS (332 minutes vs. 244 minutes, p < 0.001). An x‐bar chart of mean LOS shows special cause variation. Significant decreases were seen in median ED LOS (225 minutes vs. 204 minutes, p = 0.001), security physical interventions (2.0% vs. 0.4%, p = 0.004), and restraint use (1.7% vs. 0.1%, p < 0.001). No significant change was observed in admission rate, 72‐hour return rate, or patient elopement/agitation events. Staff surveys showed improved perception of patient satisfaction, process efficacy, and patient safety. Conclusions Use of quality improvement methodology led to a redesign that was associated with a significant reduction in mean LOS of patients with psychiatric complaints and improved ED staff perception of care.