Triplett Patrick, Dearholt Sandra, Cooper Mary, Herzke John, Johnson Erin, Parks Joyce, Sullivan Patricia, Taylor Karin F, Rohde Judith
1 Patrick Triplett, MD, Johns Hopkins Hospital, Baltimore, MD, USA.
2 Sandra Dearholt, MS, RN, Johns Hopkins Hospital, Baltimore, MD, USA.
J Am Psychiatr Nurses Assoc. 2017 Nov/Dec;23(6):422-430. doi: 10.1177/1078390317723709. Epub 2017 Jul 28.
Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care.
Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost.
Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed.
The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged.
The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.
住院环境中患者病情严重程度不断上升，导致对观察员的依赖日益增加，护理成本也随之上升。
在不增加成本的情况下，尽量减少对观察员的使用，维持护理质量和安全，并改善床位使用情况。
一所学术医疗中心的两个住院精神科病房的护理人员对“环境管理者”的使用进行了试点测试，以应对患者病情严重程度上升以及对观察员依赖增加的问题。对护理成本、床位占用率、出院量、病房关闭情况、观察员费用以及增量护理成本进行了跟踪。评估了员工满意度以及报告的患者行为/安全事件。
试点举措持续了8个月。两个病房的病房/床位关闭情况均降至零。床位占用率、患者住院天数和出院量均有所增加。观察员费用的减少以及床位占用率和患者住院天数增加所带来的收入抵消了增量护理成本。员工工作满意度提高，患者安全指标未变。
该干预措施有效降低了观察费用，提高了床位占用率和患者住院天数，同时维持了患者安全，是一种管理住院精神科病房病情严重程度的经济有效且安全的方法。
