Use of a Standardized Procedure to Improve Behavioral Health Patients’ Care: A Quality Improvement Initiative

Abstract

ProblemMeeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care. MethodsA quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints. The project used a multidisciplinary team to develop the STP scoring tool and corresponding medications. Improvement was seen in all quality metrics. Time to first medication decreased from 43 minutes to less than 5 minutes. Adopting the STP resulted in a 50% decrease in use of restraints and time in restraints. Staff injuries remained low, with less than 3.6% of staff sustaining physical injuries. DiscussionThe STP is an effective method to initiate immediate treatment of patients with signs of anxiety and aggression and thus reduce risk of violence. Additional benefits are reduced time to disposition and earlier initiation of specialized BH care. This process can be replicated in other emergency departments with similar clinical environments through the use of STPs or protocols based on state regulations.Contribution to Emergency Nursing Practice•A quality improvement, nurse-driven initiative can improve care for behavioral health patients while maintaining staff and patient safety.•Demonstrates how a nurse-driven protocol reduced time to first medication for behavioral health patients from 43 minutes to 5 minutes.•Standardized procedure instituted by nursing reduced use of restraints by more than 50%.