Use of a Dedicated, Non-Physician-led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay

ObjectivesUtilization of emergency departments (EDs) for pediatric mental health (MH) complaints is increasing. These patients require more resources and have higher admission rates than those with nonpsychiatric complaints. MethodsA multistage, multidisciplinary process to reduce length of stay (LOS) and improve the quality of care for patients with psychiatric complaints was performed at a tertiary care children's hospital's ED using Lean methodology. This process resulted in the implementation of a dedicated MH team, led by either a social worker or a psychiatric nurse, to evaluate patients, facilitate admissions, and arrange discharge planning. We conducted a retrospective, before-and-after study analyzing data 1year before through 1year after new process implementation (March 28, 2011). Our primary outcome was mean ED LOS. ResultsAfter process implementation there was a statistically significant decrease in mean ED LOS (332minutes vs. 244minutes, p<0.001). An x-bar chart of mean LOS shows special cause variation. Significant decreases were seen in median ED LOS (225minutes vs. 204minutes, p=0.001), security physical interventions (2.0% vs. 0.4%, p= 0.004), and restraint use (1.7% vs. 0.1%, p< 0.001). No significant change was observed in admission rate, 72-hour return rate, or patient elopement/agitation events. Staff surveys showed improved perception of patient satisfaction, process efficacy, and patient safety. ConclusionsUse of quality improvement methodology led to a redesign that was associated with a significant reduction in mean LOS of patients with psychiatric complaints and improved ED staff perception of care.