Reducing Length of Stay by Improving Timeliness and Efficiencyof Care for the Behavioral Health Patient in a Suburban EmergencyRoom

Abstract

Background: The average length of stay for BH patients has exceeded the Joint Commission recommended guideline that boarding time not exceed 4 hours. This has posed a threat to staff safety and hamper with patient care.

Local Problem: With the closure of several treatment centers and psychiatric units, XXXX Center has experienced a 17% increase in patients over the past year. The average length of stay for behavioral health patient is 460 minutes. The aim of this project was to reduce length of stay by improving timeliness and efficiency of care for behavioral health patients in the emergency room through the use of an anxiety screening tool and standardization of medications by 45% within 90 days.

Methods: Rapid cycle quality improvement using four plan-do-study-act cycles. Each cycle included tests of change related to team engagement, patient engagement, and two processes. Data were analyzed using run charts to evaluate the impact of interventions on outcomes.

Interventions: Staff training/ team meeting, pilot shared decision-making tool, utilization of anxiety screening tool and standardized medication tool.

Results: Re-enforcing de-escalation techniques through role plays and simulations, helping patients commit to outpatient services by initiating referral appointments, and expanding the availability of anxiety and medication tools has contributed to reducing LOS from 460 minutes to 122 minutes.

Conclusions: Incorporating simulations and role play in staff training, making outpatient referral appointments, increasing screening days and the use of a standardized medication tool has decreased the length of stay for behavioral health patients.