2019 ACMA National Poster: Improving Care of the Patient at Risk of Suicide While Decreasing ED LOS

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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


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