van den Berk-Clark Carissa, Hughes Rachel, Haywood Sally, Andrews Bart, Gordin Peggy
Behavioral Health Network of Greater St Louis.
Behavioral Health Response.
Pediatr Emerg Care. 2018 Jul;34(7):524-529. doi: 10.1097/PEC.0000000000001546.
There is no universal system to facilitate communication between emergency rooms (ERs) and pediatric mental health providers, which leads to long wait times. This project tested the concept that a group texting application (GroupMe) could improve communication between providers and could reduce wait times by allowing frontline workers to contact multiple providers simultaneously.
We compared total wait times or overall length of service of 906 ER encounters before and 921 encounters after the GroupMe texting application was implemented. To reduce differences between preintervention and postintervention time points, we utilized propensity score matching to generate a matched group of controls (total sample n = 831 ER encounters before and n = 831 ER encounters after).
Although there were no differences in total wait times when using the GroupMe application, there was a significant decrease in wait times after patients were diagnosed in ER by psychiatric provider both before (mean difference, 96.4 minutes saved; t = 2.23; P < 0.05) and after propensity score matching (mean difference, 88.0 minutes saved; t = 2.48; P < 0.05) for disposition type and acuity level.
Use of a group texting application has the potential to improve communication and wait times. However, its ability to reduce overall wait times is hampered when the limited availability of pediatric psychiatry providers results in delays in diagnosis and treatment decisions.
目前尚无通用系统来促进急诊室(ER)与儿童心理健康服务提供者之间的沟通,这导致等待时间过长。本项目测试了群组短信应用程序(GroupMe)这一概念,它可以改善服务提供者之间的沟通,并通过允许一线工作人员同时联系多个服务提供者来减少等待时间。
我们比较了在实施GroupMe短信应用程序之前的906次急诊室就诊和之后的921次就诊的总等待时间或服务总时长。为了减少干预前和干预后时间点之间的差异,我们利用倾向得分匹配来生成一组匹配的对照组(总样本量为干预前831次急诊室就诊和干预后831次急诊室就诊)。
虽然使用GroupMe应用程序时总等待时间没有差异,但在精神科服务提供者对患者在急诊室进行诊断后,无论是在倾向得分匹配之前(平均差异,节省96.4分钟;t = 2.23;P < 0.05)还是之后(平均差异,节省88.0分钟;t = 2.48;P < 0.05),处置类型和 acuity 水平的等待时间都有显著减少。
使用群组短信应用程序有可能改善沟通并减少等待时间。然而,当儿童精神科服务提供者数量有限导致诊断和治疗决策延迟时,其减少总体等待时间的能力会受到阻碍。