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

Autor:	Uspal, Neil G., Rutman, Lori E., Kodish, Ian, Moore, Ann, Migita, Russell T., Walthall, Jennifer D. H.
Předmět:	COMPETENCY assessment (Law) EMERGENCY medicine HEALTH care teams LENGTH of stay in hospitals HOSPITAL admission & discharge HOSPITAL emergency services EVALUATION of medical care MEDICAL needs assessment MEDICAL quality control MEDICAL care use PATIENTS PEDIATRICS PSYCHIATRIC nursing SCHOLARSHIPS SOCIAL workers T-test (Statistics) DATA analysis DISCHARGE planning COLLEGE teacher attitudes ELECTRONIC health records DESCRIPTIVE statistics TERTIARY care
Zdroj:	Academic Emergency Medicine; Apr2016, Vol. 23 Issue 4, p440-447, 8p
Abstrakt:	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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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