REDUCTION OF PSYCHIATRIC PATIENT BOARDING IN THE ED

REDUCTION OF PSYCHIATRIC PATIENT BOARDING IN THE EMERGENCY ROOM ABSTRACT Objective: Psychiatric patient boarding is a public health concern and a threat to patient safety. The prevalence of psychiatric emergencies in the United States continues to increase due to the strain on mental health services. There is a dire need to address psychiatric patient boarding before it gets even worse. The purpose of this project is to identify the causes and identify measures to decrease emergency department length of stay (LOS) for psychiatric patients in the ED. This project is to help facilitate the development of a more precise nursing mental health evaluation/assessment and log to ensure shorter but thorough assessments and that psychiatric patients are seen in order of arrival respectively. The project aims at reducing LOS by 3 hours. Population and setting: All psychiatric patients presenting in Sutter Roseville ED. Methodology: I analyzed data from EMTALA log and security documentation on psychiatric patient stays in the ED. March 2015: 24 hours, April 2015: 26.6 hours, May 2015: 22.7 hrs. Results: In July 2015, we saw 180 psychiatric patients in the ED with an average LOS =22.4 (refer to table below) STAYS IN EXCESS OF 10 HOURS 32 STAYS IN EXCESS OF 20 HOURS 27 STAYS IN EXCESS OF 30 HOURS 43 @37, 35, 92 33, 52, 57, 69, 53, 47, 66, 71, 72, 71, 29, 65, 65, 42, 43, 56, 99, 54, 53, 49, 70, 43, 70, 69, 50, 65, 56, 72, 40, 64, 64, 77, 47, 55, 39, 54, 67, 46, 49, 90, TOTAL PATIENTS 180 PATIENT WATCH HOURS 4039 AVERAGE LOS=22.4 Conclusion: The project aim was to reduce LOS by 3hours; this goal was not achieved. Numerous factors negatively affected the project, these which include, time constraints, travelers (inconsistency in staffing) and EHR. There was not enough time to train the staff on the proper use of the mental health log and mental health assessment. In addition, due to the implementation of the EHR in this same time frame, travel nurses were brought in to cover regular nurses who were being trained on EHR use. With the inconsistency in staffing, the log and assessment tools were not fully utilized hence affecting results