1. Emergency Dept. Process Improvement for Behavioral Health Patients
Strategies for Improving Care for Behavioral Health Patients That Present to an ED
Presenter
Larry Phillips, DCSW
Program Manager 1

2. TOPICS FOR TODAY
System improvement for behavioral health patients in the ED
Example of improvement: St. Anthony Hospital
Questions

3. Emergency Department
Part of SSM Health, St. Anthony was the first hospital established in Oklahoma and is largest with 774 licensed beds.
Serves as a regional referral facility with specialties in cardiology, oncology, surgery and behavioral medicine.
The Behavioral Medicine Center is licensed for 251 beds, includes acute inpatient programs for geriatrics and adults, as well as acute and residential inpatient care for adolescents and children.
56,312 Main ER visits in 2015
81,074 in our Freestanding ERs (4)
9,274 Behavioral Health ER visits in 2015
11,034 Total Behavioral Health visits
18% to 20% of the admissions are behavioral health 3

4. 4

6. Patient completes yellow form indicating they are
MENTAL HEALTH
PT PRESENTS IN THE ED ↓
Patient completes yellow form
indicating they are
Homicidal, suicidal or psychotic
Orange armband placed on patient, and
Mental Health Tech notified to go on standby
Security accompanies patient to appropriate holding area
(i.e.: secure holding, ED patient room)
SPOE and Triage Nurse notified
Triage and MH assessment initiated
ED Provider assess patient –
performs MSE ←
Registration is notified to register patient →
DOES NOT need medical or psychiatric treatment
DOES need medical or psychiatric treatment
SPOE provides appropriate resources
Patient discharged
home with appropriate
resources
Placed in a medical or mental health bed once
cleared by ED and bed located. Tech on
standby
until
placement
/transfer is completed

7. Benefits to a Mental Health Tech in an ER
Safety of patients
AWOL reduction
Decrease in staff injuries
Patient satisfaction
Staff satisfaction
Treatment can start prior to being placed inpatient
Patient advocate 7

8. Preparing for Change
Hospitals vary in organizational culture, and the type of culture relates to the safety climate within the hospital. These results suggest a healthcare organization's culture is a critical factor in development of its patient safety climate and in the successful implementation of quality improvement initiatives. British Med Journal
Organizational Culture: Variation Across Hospitals and Connection to Patient Safety Climate
Guide

9. 9

10. Guidelines for Cultural Change
Formulate a clear strategic vision
Display top-management commitment
Model culture change at the highest level
Modify the organization to support organizational change: identify current systems, policies, procedures and rules to be changed to align with the new values & desired culture.
Select and socialize new employees and terminate those unwilling to change.
Develop ethical and legal sensitivity
Include a periodic evaluation process to monitor the change progress and identify areas that need further development.

11. Key Questions What are we trying to accomplish?
How will we know we have made an improvement?
What changes can we make that we predict will result in improvement?

12. Getting a Better Result: The Basic Rules
Establish a goal
Identify a process
Involve others
Try changes
Measure results
Repeat

13. “CULTURE EATS PROCESS FOR LUNCH”

14. “Every System is perfectly designed to achieve the result it gets
“Every System is perfectly designed to achieve the result it gets.” “If you want a different result, you have to change the system.” Donald Berwick, MD and others