County and hospital mental health collaborative in the emergency department
Theresa Hyer, MSN, PHN
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Session I presented Saturday, September 16, 2017
Purpose: The aim of this collaborative is to offer an innovative solution for caring for the emergent needs of the mental health patient arriving at the emergency department(ED) in crisis. The Mental Health Emergency Collaborative is an integrated team made up of county mental health master level crisis workers, county mental health emergency psychiatry, emergency telepsychiatry, and ED staff. Working together the team members are able to emergently complete a psychiatric assessment, medically clear, medicate, and set up a comprehensive safety plan to assist the patient to return safely to the community. This allows the team to only hospitalize those that truly need the scarce psychiatric bed resource.
Design: The collaborative is an evidence-based project focused on improving the treatment and throughput of the emergency department psychiatric patient in crisis.
Setting: Level three trauma center with 69000 patient visits a year.
Participants/Subjects: Participants included 100% of the mental health patient visiting the emergency department, the county mental health employees, and the emergency department nurses and physicians.
Methods: Upon the arrival of the mental health patient to the ED, treatment plan begins with the patient receiving a rapid medical screening by the ED physician and immediate notification of the mental health team. After assessment and medical clearance, an ED nurse, county mental health crisis worker, and emergency tele-psychiatrist conduct a patient evaluation based on a crisis stabilization algorithm. The algorithm identifies three options: the mental health patient’s psychiatric hold can be timely rescinded if the patient does not appear in crisis and both telepsychiatry and the county mental health worker agree; or evaluation warrants further psychiatric treatment and medication, or the patient will need more intensive psychiatric evaluation and possible hospitalization. The goal is to get the team involved immediately on arrival and begin the plan for discharge or placement at that time. Prior to this collaboration, patients would be waiting hours for diagnostic test and medical clearance before the mental health worker became involved in the care taking not just hours but often days to get the patient treated and placed.
Results/Outcomes: The turnaround time for the mental health patient awaiting admission to a mental health facility took between 25 to 27 hours, since the collaborative, we have seen turnaround times of 18 to 19 hours. We have decreased the length of stay of each patient by seven hours. Our mental health patients, who were discharged home, went from fourteen hours to nine hours, with a reduction of over 5 hours. In addition, the assessment/treatment has reduced the number of inpatient hospitalizations, as well as cases of workplace violence seen in the ED. Positive financial impacts are also anticipated from the decreases in turn-around times, nursing/sitter hours, worker’s compensation costs, and number of inpatient beds needed.
Implications: The master level county mental health worker, telepsychiatry, and the ED team have created a ground breaking approach with the potential to impact not only the care of the mental health patient, but the availability of beds in any ED.
ENA 2017: Education, Networking, Advocacy. Held at America's Center Convention Center, St. Louis, Missouri
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