Use of a Standardized Procedure to Improve Behavioral Health Patients' Care: A Quality Improvement Initiative.

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California; Emergency Nursing; Emergency Service, Hospital; Humans; Mental Disorders; Nursing Staff, Hospital; Psychiatric Nursing; Quality Improvement; Time Factors; Behavioral health (BH) patients; Emergency nursing; Psychiatric patients; Restraints; Standardized procedure (STP); Violence reduction


PROBLEM: Meeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care.

METHODS: A quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints. The project used a multidisciplinary team to develop the STP scoring tool and corresponding medications. Improvement was seen in all quality metrics. Time to first medication decreased from 43 minutes to less than 5 minutes. Adopting the STP resulted in a 50% decrease in use of restraints and time in restraints. Staff injuries remained low, with less than 3.6% of staff sustaining physical injuries.

DISCUSSION: The STP is an effective method to initiate immediate treatment of patients with signs of anxiety and aggression and thus reduce risk of violence. Additional benefits are reduced time to disposition and earlier initiation of specialized BH care. This process can be replicated in other emergency departments with similar clinical environments through the use of STPs or protocols based on state regulations. Contribution to Emergency Nursing Practice.




Emergency Medicine