American Association for Emergency Psychiatry Recommendations to Address Psychiatric Staff Shortages in Emergency Settings

Richmond, Janet S.; Dragatsi, Dianna; Stiebel, Victor G.; Rozel, John S.; Rasimas, Joseph J.

doi:10.1176/appi.ps.201900501

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…The increased flexibility demonstrated by these innovations provide examples of potential long-term policy and practice amendments that may improve the care of children presenting with MH crises in the PED. Future disaster and pandemic preparedness can incorporate these findings with existing policy and practice recommendations 12 , 13 , 14 to build reserve capacity for pediatric MH care into systems.…”

Section: Discussionmentioning

confidence: 99%

Mental Health and COVID-19 in Pediatric Emergency Departments: Perspectives From Directors

Bowden

Worsley

Doupnik

2022

Journal of Adolescent Health

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Section: Discussionmentioning

confidence: 99%

Mental Health and COVID-19 in Pediatric Emergency Departments: Perspectives From Directors

Bowden

Worsley

Doupnik

2022

Journal of Adolescent Health

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“…24 As burden on the emergency care system rises in the USA, [25][26][27][28] these systems-level challenges are particularly relevant for patients at risk for agitation because behavioural and de-escalation techniques require investment in time and effort to build a strong rapport and trusting therapeutic relationship with the patient. Given that clinicians may have difficulty accurately identifying patients at risk for agitation and access to expert psychiatric evaluation in such settings may be limited, [29][30][31][32] there is a significant mismatch between resources available and application of those resources to individuals who would most benefit from early risk assessment and intervention. A recent prospective study observing 100 at-risk patients in the ED found that over 60% of individuals develop agitation more than 30 min into their visit, [33][34][35] presenting opportunities to prevent agitation earlier in the course.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol

Wong,

Nath,

Shah

et al. 2024

BMJ Open

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Introduction The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes. Methods and analysis This study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial. Ethics and dissemination Ethical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications. Trial registration number NCT04959279; Pre-results.

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“…Clinicians and leadership recognize that ED-based care for suicidality needs to improve but often face substantial constraints in effecting change [11,12]. The dearth of effective care for suicidality in the ED can be attributed to a wide range of factors, including a hectic milieu focused on patient flow [13], a shortage of behavioral health (BH) providers [14], and a shortfall in suicide-related skills and confidence among ED clinicians [15,16]. With these barriers in mind, we set out to adapt the ED-SAFE intervention to become "ReachCare," leveraging technology to make the intervention scalable in resource-constrained EDs, while avoiding a corresponding loss in fidelity.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial

Larkin¹,

Tulu²,

Djamasbi³

et al. 2023

JMIR Ment Health

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Background Emergency departments (EDs) manage many patients with suicide risk, but effective interventions for suicidality are challenging to implement in this setting. ReachCare is a technology-facilitated version of an evidence-based intervention for suicidal ED patients. Here, we present findings on the acceptability and quality of ReachCare in the ED, as well as a comparison of these measures across 3 potential delivery modalities Objective Our aim was to test the feasibility of the ReachCare intervention in its entirety through conducting a pilot study with patients presenting with suicidality to the ED. We tested three different ways of receiving the ED-based components of ReachCare: (1) self-administered on the tablet app using a chatbot interface, (2) administered by an in-person clinician, or (3) administered by a telehealth clinician. Methods In total, 47 ED patients who screened positive for suicide risk were randomly allocated to receive one of three delivery modalities of ReachCare in the ED: (1) self-administered on the patient-facing tablet app with a chatbot interface, (2) delivered by an in-person clinician, or (3) delivered by a telehealth clinician, with the latter two using a clinician-facing web app. We measured demographic and clinical characteristics, acceptability and appropriateness of the intervention, and quality and completeness of the resulting safety plans. Results Patients assigned high ratings for the acceptability (median 4.00/5, IQR 4.00-4.50) and appropriateness (median 4.00/5, IQR 4.00-4.25) of ReachCare’s ED components, and there were no substantial differences across the 3 delivery modalities [H(acceptability)=3.90, P=.14; H(appropriateness)=1.05, P=.59]. The self-administered modality took significantly less time than the 2 clinician modalities (H=27.91, P<.001), and the usability of the self-administered version was in the “very high” range (median 93.75/100, IQR 80.00-97.50). The safety plans created across all 3 modalities were high-quality (H=0.60, P=.74). Conclusions Patients rated ReachCare in the ED as highly acceptable and appropriate regardless of modality. Self-administration may be a feasible way to ensure patients with suicide risk receive an intervention in resource constrained EDs. Limitations include small sample size and demographic differences between those enrolled versus not enrolled. Further research will examine the clinical outcomes of patients receiving both the in-ED and post-ED components of ReachCare. Trial Registration ClinicalTrials.gov NCT04720911; https://clinicaltrials.gov/ct2/show/NCT04720911

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American Association for Emergency Psychiatry Recommendations to Address Psychiatric Staff Shortages in Emergency Settings

Cited by 13 publications

References 11 publications

Mental Health and COVID-19 in Pediatric Emergency Departments: Perspectives From Directors

Mental Health and COVID-19 in Pediatric Emergency Departments: Perspectives From Directors

Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol

Comparing the Acceptability and Quality of Intervention Modalities for Suicidality in the Emergency Department: Randomized Feasibility Trial

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