Written by Jennifer Thew, RN
Around 2012, Ajimol Lukose, DNP, RN-BC, nursing director at Swedish Covenant Hospital in Chicago, noticed a trend—more patients with behavioral health issues were seeking treatment in the emergency department. This development came on the heels of the state cutting $113.7 million in general funds from its mental health budget, and Chicago closing of six of its 12 city-run mental health clinics.
"There was a reduction in mental health clinics, so the follow-up or outpatient programs were limited. That resulted in patients showing up in the emergency department," Lukose told me.
On any given day, there could be as many as six or seven behavioral health patients in the ED.
"Our emergency department was struggling with patients with mental health issues staying there for three and four days and waiting for state transfer, especially unfunded patients," she said.
At the same time, Lukose needed to implement a project for the doctorate of nursing practice degree she was working toward. She has a background in psychiatric nursing and thought she could help address some of the issues around caring for this patient population by developing a safe care delivery model to improve care quality and reduce length of stay in the ED.
Her results were even better than expected.
The Best-Laid Plan
Lukose developed a number of goals for the project. Short-term, she wanted the initial behavioral health assessment in the ED to occur within one hour of its order time and to have behavioral health interventions initiated within two hours of the consultation order time.
Long-term, she wanted to decrease behavioral health patients' ED length of stay, the use of sitters and behavioral restraints, elopement events, and labor costs.
Through a literature review, she identified three best practices to support these goals:
- Place a psychiatric liaison in the ED
- Designate a dedicated area in the ED for behavioral health patients, separate from the general patient population
- Create guidelines, protocols, and policies to direct ED staff on how to care for behavioral health patients
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