Nicome Roger, Lo Huay-Ying, Gupta Sheena, Khan Adrita, Lee Alice, Molchen Wallis, Neubauer Hannah, Ramgopal Veena, Lyn Michelle, Weber Emily, Vachani Joyee
Department of Pediatrics at Baylor College of Medicine, Texas Children's Hospital, Houston, Tex.
Pediatr Qual Saf. 2021 Mar 10;6(2):e393. doi: 10.1097/pq9.0000000000000393. eCollection 2021 Mar-Apr.
Due to limited psychiatric hospital availability, increasing numbers of pediatric patients with behavioral health (BH) needs are hospitalized in medical units in the US Patients and staff are at increased risk for safety events like self-harm or aggression. Our study aimed to decrease safety events by 25% over a year among hospitalized children with BH diagnoses by implementing an intervention bundle.
A multidisciplinary team developed and implemented a BH intervention bundle that included a BH equipment cart, an electronic medical record tool for BH patient identification/stratification, a de-escalation team, daily operational BH phone call, and staff training with a safety checklist. The primary outcome measure was the number of reported safety events in BH patients. Process measure was "medically avoidable days", wherein a medically cleared patient remained hospitalized awaiting transfer to inpatient psychiatric units; balance measure was staff perception of the workflow.
Although not statistically significant, we noted a downward trend in safety events per 1,000 patient days from 0.47 preintervention to 0.34 postintervention (28% decrease). Special cause variation was not achieved for BH safety events or medically avoidable days. Although one-third of staff members felt the BH bundle was helpful, many reported it as impeding workflow and expressed ongoing discomfort caring for BH patients.
The implementation of a BH intervention bundle requires significant institutional support and interdisciplinary coordination. Despite additional training, equipment, and staff support, we did not achieve measurable improvements in patient safety and care coordination. Additional studies to measure impact and improve care for this population are needed.
由于精神病医院床位有限，美国越来越多有行为健康（BH）需求的儿科患者在医疗科室住院。患者和工作人员面临自我伤害或攻击等安全事件的风险增加。我们的研究旨在通过实施一套干预措施，在一年时间内将BH诊断住院儿童的安全事件减少25%。
一个多学科团队开发并实施了一套BH干预措施，包括一个BH设备推车、一个用于BH患者识别/分层的电子病历工具、一个降级处理团队、每日BH业务电话，以及带有安全检查表的工作人员培训。主要结局指标是BH患者报告的安全事件数量。过程指标是“医疗上可避免的天数”，即一名医学上已获许可的患者仍住院等待转至住院精神科病房；平衡指标是工作人员对工作流程的看法。
尽管无统计学意义，但我们注意到每1000患者日的安全事件呈下降趋势，从干预前的0.47降至干预后的0.34（下降28%）。BH安全事件或医疗上可避免的天数未实现特殊原因变异。虽然三分之一的工作人员认为BH干预措施有帮助，但许多人报告称这阻碍了工作流程，并表示在护理BH患者时仍感到不适。
实施BH干预措施需要大量的机构支持和跨学科协调。尽管有额外的培训、设备和工作人员支持，但我们并未在患者安全和护理协调方面取得可衡量的改善。需要进行更多研究来衡量对这一人群的影响并改善护理。
