Improving Care of the Patient at Risk of Suicide While Decreasing ED Length of Stay Jennifer Chaffer, LMSW ACM-SW Background
Primary Intervention Strategies - LOS
Primary Intervention Strategies - Clinical
Maintaining compliance with The Joint Commission's standards around suicide risk assessment and mitigation in the Emergency Department setting requires time- and resource-intensive processes, which must be balanced with the need to continually monitor and manage length of stay. This poster illustrates one hospital's journey to implement processes and tools to provide better management of the patient at risk of suicide while simultaneously reducing the average length of stay for patients with a primary mental health chief complaint in the ED.
• Implement use of text pages to inform MSW of patient with positive suicide screen (reduces volume of calls to MSW)
• Universal suicide risk screening ED • Implementation of validated suicide risk assessment tool (SAFE-T) by MSW • Implementation of checklist to direct "room clearance" protocol • Implementation of reference tool to direct risk mitigation strategies based on assessed risk level
• Introduce 30-minute target for MSW response to positive screen • When possible, station MSW in triage area, for immediate response to positive screen • Implement on-call MSW team (6pm-3am) to respond to late-day volume surges
390 380
Driving The Work Forward
LOS (in minutes) of ED Patients w/Behavioral Health Chief Complaint 376
374
370
Steering Team:
setting priorities and breaking down barriers
380
350
Quality Rep
341
300
ED Medical Director
333
Social Work Manager
314
CY17 Median
JAN
FEB
MAR
APR
MAY
Monthly LOS (Minutes)
Manager of Inpatient Psych Unit ED Clinical Nurse Leader
Transferred to Psych Hospital 31%
ED Informatics Rep ED Bedside Nurses
Process Excellence Facilitator ED Social Workers
80%
JUN
JUL
AUG
SEP
OCT
NOV
― Target = 360 (Minutes)
65%
60%
54%
50%
51%
10% 0%
Questions: chafferj@mercyhealth.com
Admitted Inpatient 8%
NOV 2017 thru DEC 2018
• Delivering care to patients who are at risk of suicide in a high-
quality, compliant manner does not equate to increasing LOS in ED • Empowering frontline colleagues to design and implement new initiatives can help an organization achieve its compliance and LOS goals
• Ongoing auditing for compliance with assessment guidelines and safety interventions • Belongings management • Visitor management • Continue to ask the question: How do we provide excellent care in a way that respects the patient and keeps them safe, but doesn't make them feel like a prisoner, and regret asking for help
40%
20%
designing, evaluating, and revising intervention strategies
AUG 2017 thru OCT 2017 Baseline
Home / Outpatient 59%
Where Do We Go From Here: The Work Yet to Do
30%
ED Process Excellence Team:
DEC
Transferred to Psych Hospital 28%
Conclusions
MSW Assessment Initiated within 30 mins of Positive Suicide Screen (%)
70%
Home / Outpatient 52%
Admitted Inpatient 15%
310
ED CNS
Other 5%
345
320
Internal Medicine Physician
Security Director
Other 2%
330
Risk Management Rep
Inpatient Nursing Rep
342
Direct Risk Mitigation Strategies
Less Restrictive Patient Placement
364
357 342
340
ED Nurse Manager
364
360
360
“Room Clearance" Protocol Checklist
0%
Baseline
OCT
Monthly Performance
NOV
― Target = 80%
DEC
References "Special Report: Suicide Prevention in Health Care Settings." Joint Commission Perspectives. Nov 2017. "Suicide Risk Reduction Recommendations." The Joint Commission. 1