Improving Mental Health Communication From the Pediatric Emergency Department to Primary Care

Abstract

Objectives Suicide is a leading cause of adolescent death, and emergency department (ED) visits are recognized as an opportunity to identify at-risk youth. For patients screening positive for mental health concerns, we implemented a quality improvement initiative to enhance documentation of results and interventions in the ED, increase communication between the ED and primary care providers (PCPs), and increase PCP follow-up. Methods Interventions included education, feedback, and an alert in our electronic health record. Completion of a Behavioral Health Screen (BHS-ED) initiates an alert that reminds ED providers how to document and communicate results and needed follow-up to the PCP. We reviewed a random monthly sample of ED charts for adolescents 14 to 19 years old presenting with nonpsychiatric complaints who screened positive for severe depression or suicidality. Outcome measures included documentation of BHS-ED results in the ED note, communication of positive results to the PCP, PCP follow-up of results, and ED return visits. Results Documentation of BHS-ED results increased from 73% at baseline to 88% of patients after the intervention. For patients discharged from the ED with nonpsychiatric chief complaints, communication to PCPs increased from 1% at baseline to 40% during the final 3 months of the study. When PCP communication occurred, 67% of in-network PCPs followed up with patients versus 5% when no communication took place from the ED. Conclusions A multifaceted intervention including education and an electronic health record alert improved ED documentation, communication, and PCP follow-up of issues identified during ED-based mental health screens.

The long and winding road: perspectives of people and parents of children with mitochondrial conditions negotiating management after diagnosis

“…Missed opportunities to interact were reported and were often due to lack of timely or appropriate communication. Lack of communication between different health care providers, even within the same organisation has been reported in other studies (e.g., in the NHS [24]) and is not restricted to communication around people with a rare disease (e.g., people with an acute mental health issue [25]). A patient seeing a health care provider working on their own may be confident of receiving high quality care if their provider follows easily accessible and widely accepted evidencebased guidelines.…”

Communication pathways from the emergency department to community mental health services: A systematic review

“…A supportive person to speak to with the family will work to identify changes that the person can bring into their life and assist with exploring the person's sense of capacity to change. These follow up strategies were shown to be valuable to improve after care arrangements with three of the included studies in this review (Esposito et al 2020;Grupp-Phelan et al 2012, 2019.…”

“…Four studies (Esposito et al 2020;Grupp-Phelan et al 2019Hopper et al 2011) included in this review whose participants were adolescents included mental health screening and varying interventions, for example, electronic record alerts, phone follow-up, motivational interviewing plus support coordination, whereas studies with adult participants focussed on support coordination only. It is accepted that a young person may present to the ED with a mild medical complaint, but also have a mental health issue (Nager et al 2017).…”

“… 2012 ); an electronic record enhanced strategy (Esposito et al . 2020 ) and results from a phone follow‐up intervention (Hopper et al . 2011 ).…”

Emergency Department Initiated Mental Health Interventions for Young People

“…Given that the primary purpose of EDs is to provide acute care services, more long-standing mental health needs are often missed when individuals present with physical health complaints 53 . A potential solution is targeted and brief screening programs as evidenced by positive results from studies that analyze screening interventions for depression and suicide risk in the ED 56–58 . However, as discussed, screening is only effective if accompanied by clear and predetermined referral pathways.…”