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O'Donnell R, Hinderer KA, Belanger D, Chenard D, Boyle E, Borrup K, Fish M, Brimacombe M, Rogers S. Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool. J Emerg Nurs 2024; 50:342-353. [PMID: 38597852 DOI: 10.1016/j.jen.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION The national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. METHODS This quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. RESULTS With over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DISCUSSION For emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.
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Eapen V, Gerstl B, Ahinkorah BO, John JR, Hawker P, Nguyen TP, Brice F, Winata T, Bowden M. Evidence-based brief interventions targeting acute mental health presentations for children and adolescents: systematic review. BJPsych Open 2024; 10:e78. [PMID: 38602192 PMCID: PMC11060074 DOI: 10.1192/bjo.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. AIMS To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0-17 years) presenting with an acute mental health condition. METHOD A systematic literature search was conducted, and the studies' methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. RESULTS We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent-child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. CONCLUSIONS This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.
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Affiliation(s)
- Valsamma Eapen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Brigitte Gerstl
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Bright Opoku Ahinkorah
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and School of Public Health, University of Technology Sydney, Australia
| | - James Rufus John
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; and Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Patrick Hawker
- Discipline of Psychiatry and Mental Health, University of New South Wales, Australia
| | - Thomas P. Nguyen
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Mental Health Team, School of Medicine, Western Sydney University, Australia
| | - Febe Brice
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia
| | - Teresa Winata
- Academic Unit of Infant, Child, and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District and Ingham Institute, Australia; Discipline of Psychiatry and Mental Health, University of New South Wales, Australia; and Infant, Child and Adolescent Mental Health Service (ICAMHS), South Western Sydney Local Health District, Australia
| | - Michael Bowden
- Child and Youth Mental Health, New South Wales Ministry of Health, Australia; Sydney Medical School, University of Sydney, Australia; and Department of Psychological Medicine, Sydney Children's Hospitals Network, Australia
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Simpson SA, Loh R, Elliott L, Everhart R, Bass C, Bol K, Boylls S, Podewils L. A Mortality Surveillance Collaboration Between a Health System and Public Health Department. Am J Public Health 2023; 113:943-946. [PMID: 37410981 PMCID: PMC10413737 DOI: 10.2105/ajph.2023.307335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 07/08/2023]
Abstract
We describe a collaboration between a health system and public health department to create a mortality surveillance system. The collaboration enabled the health system to identify more than six times the number of deaths identified through local system medical records alone. This powerful epidemiological process, combining the nuanced data captured through clinical care in health systems with subsequent data on mortality, drives quality improvement, scientific research, and epidemiology that can be of particular benefit to underserved communities. (Am J Public Health. 2023;113(9):943-946. https://doi.org/10.2105/AJPH.2023.307335).
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Affiliation(s)
- Scott A Simpson
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Ryan Loh
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Laura Elliott
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Rachel Everhart
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Conlin Bass
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Kirk Bol
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Steve Boylls
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Laura Podewils
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
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Cassidy L, Quirke MB, Alexander D, Greene J, Hill K, Connolly M, Brenner M. Integrated care for children living with complex care needs: an evolutionary concept analysis. Eur J Pediatr 2023; 182:1517-1532. [PMID: 36780041 PMCID: PMC9924191 DOI: 10.1007/s00431-023-04851-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/14/2023]
Abstract
Children with complex care needs (CCNs) are in need of improved access to healthcare services, communication, and support from healthcare professionals to ensure high-quality care is delivered to meet their needs. Integrated care is viewed as a key component of care delivery for children with CCNs, as it promotes the integration of healthcare systems to provide family and child-centred care across the entire health spectrum. There are many definitions and frameworks that support integrated care, but there is a lack of conceptual clarity around the term. Furthermore, it is often unclear how integrated care can be delivered to children with CCNs, therefore reinforcing the need for further clarification on how to define integrated care. An evolutionary concept analysis was conducted to clarify how integrated care for children with CCNs is defined within current literature. We found that integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. Conclusion: Given the variation in terms of study design, outcomes, and patient populations this paper highlights the need for further research into methods to measure integrated care. What is Known: • Children with complex care needs require long-term care, and are in need of improved services, communication, and information from healthcare professionals to provide them with the ongoing support they need to manage their condition. • Integrated care is a key component in healthcare delivery for children with complex care needs as it has the potential to improve access to family-centred care across the entire health spectrum. What is New: • Integrated care for children with CCNs refers to highly specialised individualised care within or across services, that is co-produced by interdisciplinary teams, families, and children, supported by digital health technologies. • There is a need for the development of measurement tools to effectively assess integrated care within practice.
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Affiliation(s)
- Lorna Cassidy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Mary Brigid Quirke
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Denise Alexander
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Jo Greene
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Katie Hill
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
| | - Maria Brenner
- School of Nursing, Midwifery and Health Systems, University College Dublin, Health Sciences Building, Belfield, Dublin 4 Ireland
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Use of an Agitation Measure to Screen for Suicide and Self-Harm Risk Among Emergency Department Patients. J Acad Consult Liaison Psychiatry 2023; 64:3-12. [PMID: 35850464 DOI: 10.1016/j.jaclp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Suicidality alone is insensitive to suicide risk among emergency department (ED) patients. OBJECTIVE We describe the performance of adding an objective assessment of agitation to a suicide screening instrument for predicting suicide and self-harm after an ED encounter. METHODS We tested the performance of a novel screener combining the presence of suicidality or agitation for predicting suicide within 90 days or a repeat ED visit for self-harm within 30 days using retrospective data from all patients seen in an urban safety net ED over 27 months. Patients were assessed for suicidality using the Columbia-Suicide Severity Rating Scale-Clinical Practice Screener and for agitation using either the Behavioral Activity Rating Scale or Richmond Agitation Sedation Scale. We hypothesized that a screener based on the presence of either suicidality or agitation would be more sensitive to suicide risk than the Columbia-Suicide Severity Rating Scale-Clinical Practice Screener alone. The screener's performance is described, and multivariable regression evaluates the correlations between screening and outcomes. RESULTS The sample comprised 16,467 patients seen in the ED who had available suicide screening and agitation data. Thirteen patients (0.08%) died by suicide within 90 days after ED discharge. The sensitivity and specificity of the screener combining suicidality and agitation for predicting suicide was 0.69 (95% confidence interval, 0.44-0.94) and 0.74 (0.44-0.94), respectively. The sensitivity and specificity for agitation combined with positive suicide screening for self-harm within 30 days were 0.95 (0.89-1.00) and 0.73 (0.73-0.74). For both outcomes, augmenting the Columbia-Suicide Severity Rating Scale-Clinical Practice Screener with a measure of agitation improved both sensitivity and overall performance compared to historical performance of the Columbia-Suicide Severity Rating Scale-Clinical Practice Screener alone. CONCLUSIONS Combining a brief objective measure of agitation with a common suicide screening instrument improved sensitivity and predictive performance for suicide and self-harm risk after ED discharge. These findings speak to the importance of assessing agitation not only for imminent safety risk during the patient encounter but also for reducing the likelihood of future adverse events. This work can improve the detection and management of suicide risk in emergency settings.
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More than Suicide: Mortality after Emergency Psychiatric Care and Implications for Practice. J Acad Consult Liaison Psychiatry 2022; 63:354-362. [PMID: 35017123 DOI: 10.1016/j.jaclp.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Emergency departments (EDs) provide vital mental health services. ED patients with behavioral health presentations, particularly suicidal ideation, are at increased risk of death by suicide, medical illness, trauma, or overdose. Causes of death for patients who receive specialty emergency psychiatric services remain undescribed. OBJECTIVE We describe the incidence and cause of death after care in a psychiatric emergency service (PES). METHODS Mortality data were obtained for all adult patients treated in a safety net ED from April 2016 to June 2020. Causes of death were categorized as medical, external (accidents, overdoses, and homicide), or suicide and compared between PES patients and ED patients who were not treated in the PES. Correlates of mortality were described for PES patients. RESULTS We analyzed 164,422 encounters including 6,063 PES visits. Mortality in the 30 days after discharge was 0.3% among PES patients and 0.6% among medical ED patients. At both 30 and 365 days, PES patients were more likely to die by suicide than were medical ED patients, and ED patients were more likely to die by medical causes. Among PES patients who died within 365 days, 46% died by medical causes, 32% by external causes, and 23% by suicide. In multivariable analyses, age was associated with all-cause, medical, and external mortality after a PES visit; opioid and stimulant use disorders were associated with all-cause and external mortality. CONCLUSIONS Most patients who die after receiving emergency psychiatric care die by medical and external causes such as accidents, overdose, and homicide. Patients who are older and have opioid or stimulant use disorders are at higher risk of non-suicide mortality. We propose interventions to re-imagine emergency psychiatric care and address non-suicide mortality among psychiatric patients treated in emergency and crisis settings.
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