Use of a Dedicated, Non–Physician‐led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay

Abstract

Objectives: Utilization of emergency departments (EDs) 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.ACADEMIC EMERGENCY MEDICINE 2016;23:440-447 © 2016 by the Society for Academic Emergency Medicine M ental health (MH) disorders are common in children, with an estimated 13%-20% of children in the United States experiencing a mental disorder in a given year.1-5 They also are increasing, with a reported 24% increase in inpatient MH and substance abuse admissions among children from 2007 to 2010 6 and an 80% increase in hospital stays for children with mood disorders from 1997 to 2010. 7 Despite this increasing prevalence, psychiatric services for children in many parts of the country are limited, 8 leaving many with unmet psychiatric care needs. 9Nationally, pediatric emergency department (ED) visits for MH issues increased by over 20% between 2001 and 2010. 10 Pediatric EDs (PEDs) have also seen high volumes of patients presenting with psychiatric crises, with 3.3% of PED visits related to MH issues in one

The Role Of The Pediatric Nurse In Discharge Planning; Identifying Gaps In Sri Lanka

“…Of the 16 studies, 11 studies were conducted in particular health care units (Arad et al, 2007;Dellenmark-Blom & Wigert 2014;Ekim & Ocakci 2016;Gallotto et al, 2019;Góes & Cabral 2017;Lerret et al, 2017;Meerlo-Habing et al, 2009;Pfeil et al, 2007;Schuh et al, 2016;Wells et al, 2017;Smith et al, 2018), 4 in acute medical setups Holland et al, 2014Holland et al, , 2015Weiss et al, 2017), and one in an Emergency Department (Uspal et al, 2016). Of the 16 studies, five studies included nurses' involvement in the post-discharge period Lerret et al 2017;Meerlo-Habing et al, 2009;Pfeil et al, 2007;Wells et al, 2017), eight studies included about nurses' involvement before the hospital discharge (Arad et al, 2007;Gallotto et al, 2019;Góes & Cabral 2017;Holland et al, 2014Holland et al, , 2015Schuh et al, 2016;Weiss et al, 2017;Smith et al, 2018), and 2 studies described both pre-discharge and post-discharge involvement of the nurse (Dellenmark-Blom & Wigert 2014;Ekim & Ocakci 2016).…”

“…Efficient collaboration with health providers inside the hospital will allow more opportunities for nurses to involve in the patient discharge planning, which increases patient and family satisfaction Góes & Cabral 2017;Holland et al, 2015;Uspal et al, 2016;Smith et al, 2018). This collaborative work will work towards speeding up the recovery of the child (Wells et al, 2017).…”

“…Parental self-efficacy perception (Ekim & Ocakci 2016), satisfaction (Arad et al, 2007;Uspal et al, 2016;Smith et al, 2018), experience with home care (Dellenmark-Blom & Wigert, 2014;Lerret et al, 2017), perception on care received (Pfeil et al 2007), care giver's comfort and needs (Gallotto et al, 2019;Góes & Cabral, 2017) have been assessed because every discharge planning intervention needs collaboration with a parent, caregiver or the family of the child (Weiss et al, 2017). Assessment of discharge readiness of the patient and family is an essential aspect of the discharge process, which needs interactions with them throughout the stay (Schuh et al, 2016).…”

A Systematic Review on Lean Applications’ in Emergency Departments

“…Two studies used the Lean Thinking, Multidisciplinary, and Statistics approach. Uspal et al [ 65 ] found a significant reduction in the mean length of hospital stay of pediatric patients with psychiatric complaints and the best perception of Emergency Department care staff. Finally, Ref.…”

“…Patients discharge has also been improved by as much as 40% [ 62 ]. Remote scheduling avoids aggravating oncology patients’ clinical condition creating reductions in displacement and waiting time [ 65 , 66 ]. Implementing a new layout is another benefit that positively impacts the organization’s activities and patient flow [ 16 ].…”