Boafo Addo, Greenham Stephanie, Cloutier Paula, Abraham Shanika, Dumel Michele, Gendron Valerie, Rowsell Derek
Mental Health Program, CHEO, Ottawa, ON, Canada.
CHEO Research Institute, CHEO, Ottawa, ON, Canada.
Adolesc Health Med Ther. 2020 Sep 24;11:123-133. doi: 10.2147/AHMT.S240060. eCollection 2020.
This article describes steps taken by a mental health inpatient multidisciplinary team to develop a clinical pathway for the assessment and management of suicidality in a pediatric psychiatric inpatient unit.
The setting for this project is a 19-bed inpatient psychiatry unit providing care for children and adolescents (6-17 years of age) in a tertiary care pediatric hospital in Ontario, Canada. Three Lean methodologies were used: 1) The A3 process was used to articulate a problem statement and help clarify expectations, determine goals, and uncover, address and encourage discussion of potential issues; 2) Process mapping was used to show how work process activities are sequenced from the time of the patient's admission to discharge; and 3) Standard work, where consideration was given to the breakdown of the work into categories which are sequenced, organized and repeatedly followed. Generally accepted methodologies for developing clinical pathways were used to create a framework and algorithm for the assessment and management of suicidality in psychiatrically hospitalized children and adolescents.
The clinical pathway development resulted in six steps from admission to discharge: intake process, inclusion/exclusion criteria, data integration and treatment formulation, interventions, determination of readiness for discharge, and the discharge process.
This framework, developed with the aim to standardize care for psychiatrically admitted suicidal children and adolescents, may serve as a flexible template for use in similar settings and could be adapted according to local realities and resources.
本文描述了一个心理健康住院多学科团队为制定儿科精神科住院单元自杀倾向评估与管理临床路径所采取的步骤。
本项目的实施地点是加拿大安大略省一家三级护理儿科医院中一个拥有19张床位的精神科住院单元，该单元为儿童和青少年（6 - 17岁）提供护理服务。采用了三种精益方法：1）A3流程用于阐述问题陈述，帮助明确期望、确定目标，并发现、解决和鼓励对潜在问题的讨论；2）流程映射用于展示从患者入院到出院期间工作流程活动的顺序；3）标准工作，即考虑将工作细分为按顺序排列、组织有序且反复遵循的类别。采用普遍认可的临床路径开发方法，为精神科住院儿童和青少年自杀倾向的评估与管理创建了一个框架和算法。
临床路径的开发产生了从入院到出院的六个步骤：接诊流程、纳入/排除标准、数据整合与治疗方案制定、干预措施、确定出院准备情况以及出院流程。
该框架旨在规范对精神科收治的自杀倾向儿童和青少年的护理，可作为在类似环境中使用的灵活模板，并可根据当地实际情况和资源进行调整。
