Improving Care for Psychiatric Patients in the Emergency Center
Author DetailsSarah Berry, DNP, RN, AGCNS-BC, CEN; Naomi J. Ishioka, MSN, RN, CEN; Bradley Sommers, BSN, RN
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Session C presented Thursday, September 27, 1:00-2:00 pm Purpose: The purpose of this study is to assess the usefulness of a hand-off tool which will prompt providers to address specific care needs of the psychiatric patient. The goal is to positively influence appropriate care for the physical, mental, and emotional needs of the psychiatric patient population and improve patient outcomes. Design: This study utilized a quasi-experimental research design. Setting: The study setting is a Level 2 Trauma Emergency Center which consists of approximately 41 acute care beds with three trauma bays in a 520-bed suburban hospital. Participants/Subjects: Inclusion criteria were patients 18 years and older, assigned a sitter, with a primary psychiatric complaint. Exclusion criteria were patients 17 years and younger or an employee of the study setting. Patients were selected randomly using chart review and filtering patients to those assigned a sitter. A total of 100 charts were reviewed (50 pre and 50 post). Patients in both the pre and post intervention population were mostly male and an average age of 41. Methods: A committee of EC staff members met and discussed the concerns regarding the safety and care of the psychiatric patient. The committee agreed that a hand-off tool which prompts providers to address specific care needs may be helpful to ensure proper care of psychiatric patients. Institutional Review Board (IRB) approval was gained from the study site. Pre-intervention data (n=50 charts) was collected by a retrospective method of chart review. A hand-off tool was then developed by the researchers based on the findings from the pre-intervention data.The tool included prompts such as complete the medication reconciliation, home medications ordered, and diet ordered. The EC nurses were educated on the use of the tool by the researchers through presentations and one on one coaching. Once completed, the hand-off tool was collected in a secure drawer located in the EC. The completed hand-off tools were then used to collect post-implementation data using an audit tool to review the chart.The audit tool mimicked the hand-off tool in content but was used to note whether what was indicated on the hand-off tool was actually completed. Pre and post data results were then compared (n=100 charts). Results/Outcomes: Per the results, the hand-off tool has been shown to be a viable option for improving patient care practices in the psychiatric population. A positive change (p<0.05) was noted in each category measured (medical history reviewed and updated, home medications updated and ordered, diet ordered, vital signs ordered per protocol, and medications ordered for secondary complaint). Implications: The psychiatric patient population has been growing exponentially around the country and the lack of appropriate treatment centers had led to an influx of this population in ERs. Also due to a lack of appropriate beds, the patients are staying longer in the ER and often present with secondary complaints. This project identified a cost-neutral, nurse-driven approach of using a hand-off tool for psychiatric patients to improve their care.