Compass Clinical Consulting collaborated closely with the faculty and leadership of a not-for-profit health system with 12 acute care hospitals to improve the environment of care for behavioral health patients in the Emergency Department. Compass conducted the consultation at one of the system’s locations, an 800+ bed medical center, to create a plan to be implemented across the system.

The Situation

Emergency Department leadership and staff of a southern medical center with over 800 beds were concerned about the provision of care for behavioral health patients and the overall safety of the department. Among these concerns were issues with the environment of care, challenges experienced by the ED staff, and the risk factors inherent in working with this vulnerable patient population. Additionally, boarding was used as a temporary placement for these patients because community resources did not have the adequate capacity or ability to accept patients in a timely manner. Leadership grew increasingly concerned with maintaining the safety of these patients until they were placed into a clinically appropriate environment. 

The Solution

The health system’s leadership requested assistance from Compass Clinical Consulting to conduct a consultation focused on the safe management of behavioral health patients in the emergency department (ED). Compass behavioral health consultants were deployed in order to assist the clinical and environment of care staff. Their focus was to standardize and streamline the process for determining probable risk to patient care when managing behavioral health patients in the Emergency Departments across the system’s hospitals.

At the consultation’s onset, the Compass consultants educated staff on environment of care best practices, risk factors that can lead to unsafe outcomes for patients and staff, and the most effective approaches for staff in working with behavioral health patients. A Behavioral Health Physical Environment Risk Assessment tool was developed that could be used by each facility at EDs across the system, ensuring consistency in the provision of care.

After a thorough assessment of the health center, consultants noted specific areas of concern and provided recommendations for improvement. Emphasized in these recommendations was the importance of implementing a culture of safety, which can be accomplished by establishing specific behavioral expectations, such as frequent rounding on patients and the environment, ongoing communication throughout the shift among staff, and plans on how to respond to emergent situations.

Medical Team Working On Patient In Emergency Room

Additionally, the recommendations emphasized that boarded patients must have a plan of care to meet their basic needs, and training must be provided to staff members providing direct care and those in non-clinical services. Another suggestion by consultants was to train staff in de-escalation skills and behavioral management techniques.

The Compass consultants also provided education on the difference between a safe room that is not upholding a safe environment and functional safe rooms. It was recommended that the organization develop an ED mitigation checklist on how and which items to remove from any ED room to enhance patient safety in the room. Consultants also recommended that the medical center and parent health system take the responsibility to assure it is safe and set its own standards to achieve these positive outcomes in provisions of care.

The Result

The input and recommendations from the Compass consultants were received with appreciation and enthusiasm toward implementing safe strategies and practices at the medical center. At the conclusion of the assignment, organization leadership had committed to moving to a safer environment in the ED for behavioral patients with more supportive staff.

The use of sitters in the safe rooms was adopted, and the staff recognized that placing patients in safe rooms must be prioritized. Additionally, upon one consultant’s return to the organization a few months later, four more safe rooms had been successfully established, exhibiting the health system’s embrace of feedback and a commitment to more deliberate, safe behavioral healthcare. The system is readily working to implement these solutions across its member hospitals.

More Information: Safer Mental Health Services in the Emergency Department


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