Emergency Departments (ED) across the United States, and in many countries throughout the world, are deluged with behavioral health patients. Inability to properly care for this fragile, often unpredictable population is a serious threat to public safety. This presentation will describe actions taken to safeguard patients and staff in the ED through an innovative staffing initiative. Positive outcomes associated with placing dedicated psychiatric staff in the ED will be shared.
An estimated 12 million Americans have serious mental illness. Mental health problems currently account for over 10% of ED visits; but, this number is increasing on an annual basis. Patients with psychiatric/mental health and substance abuse problems have special needs that challenge ED staff. Research by the Emergency Nurses’ Association found that ED nurses feel uncomfortable and ill-prepared to properly care for behavioral health patients. Lack of confident, competent staff caring for patients with behavioral health problems in the ED threatens the well-being of ED patients and staff, and represents a safety problem that must be remedied.
In 2017, findings of a learning needs assessment identified inadequate behavioral health knowledge among ED staff. Furthermore, ED nurses were reluctant and often dissatisfied caring for patients with behavioral health needs. Subsequently, a visionary Chief Nursing Officer proposed placing experienced psychiatric staff in the ED to provide expert care to patients and serve as valuable resources to the ED staff. This “budget-neutral” plan, which began in March 2018, was called: “Joining Forces”. Initially, the plan placed six nurses and six nursing assistants in the ED. In July 2018, a Psychiatrist was added to supervise Psychiatric residents and guide the staff in reaching goals for quality improvement. Based on increasing behavioral health visits in the ED, and the success of the “Joining Forces” initiative, additional psychiatric staff are being added to the ED staff in early 2019.
The “Joining Forces” initiative significantly improved several important quality outcomes. ED patient satisfaction scores improved from a mean rank below 25% to above 90% on a consistent basis. ED patient complaints decreased over 50% from 23 per month to less than 10 per month. Length of stay (LOS) among admitted psychiatric patients holding in the ED decreased 75% from a mean of 16 hours to 4 hours. In addition, ED staff vacancy and turnover rates; as well as, ED staff satisfaction and Culture of Safety scores have improved significantly since the “Joining Forces” initiative was initiated.
ED patients with behavioral/mental health, psychiatric and substance abuse problems have highly specialized needs that require evidence-based care by expert staff. Changes in society have created changes in the ED environment that require new approaches to care. Placing dedicated psychiatric staff in the ED improves care provided to patients with behavioral health problems, and promotes positive outcomes among all patients and staff in contemporary ED settings.