Compass Clinical Consulting worked with leadership of a Southeast health system to improve care for behavioral health patients in the Emergency Department. During the engagement, the Compass consultant performed on-site assessments and education in three of the system’s medical centers to develop a consistent approach for providing care and establish a safe and therapeutic environment for both staff and patients.

The Situation

Three medical centers in a Southeast system were struggling with providing safe, quality care to psychiatric patients in the Emergency Department. Notably, they were having issues with patient throughput in the ED due to a lack of resources in the community, which meant that not enough patients were receiving the care they needed—an issue further complicated by the complex needs of this vulnerable, high-risk patient population.

The Solution

Compass Clinical Consulting was called upon to assist the organization in providing a safe and therapeutic care environment for all staff and patients in the Emergency Departments at the three southern facilities. The goal of the project was to provide a systemic approach and tools to enable staff members to enhance the quality care provided to behavioral health patients. Additionally, the consultation would assess for compliance with federal, state, and local regulations.

The Compass consultant spent eight weeks in the three facilities, assessing standards of care and interventions; reviewing policies, procedures, and clinical tools; and implementing educational sessions at each facility focused on safety issues, therapeutic interventions, and de-escalation techniques related to care of the psychiatric patients.

Care in the emergency department

The assessment revealed that there were inconsistencies among the three facilities in how psychiatric patients were assessed when presenting in the Emergency Department. Notably, there were inconsistencies in the processes used to triage psychiatric patients and screen violent and suicidal patients for risk.

To address this issue, the Compass consultant provided a risk assessment tool and worked with the staff members to implement the tool across the three hospitals. Instrumental in this process were the physicians and physician assistants, who worked across the three facilities. The assessment also revealed issues with documentation and medication orders, ED staffing, and the environment of care.

The Result

Following the engagement, the Compass consultant provided system leadership with a comprehensive report detailing these findings and the consultant’s recommendations. This report prepared system leadership to develop a clear action plan for improving patient care and ensuring compliance with regulatory standards.

All staff received training and education regarding the process for managing behavioral health patients upon admission to Emergency Department to include staff coverage for high-risk patients, the provision of a safe environment for patients who are assessed as high-risk, and the hospital’s plan for emergency issues related to violent patients.

Staff morale also improved as a result of the consultation because nurses felt that they had a voice and that their concerns and frustrations were heard. These conversations empowered them to advocate for changes that would contribute to the safety of all staff and patients in the Emergency Department.

Additionally, system leaders were exploring the consultant’s recommendation to bring on a master’s-prepared psychiatric practitioner who could serve for all three facilities and provide support, expertise, and ongoing training for ED physicians and nurses. If hired, this professional would also collaborate with community stakeholders to increase community support of behavioral health services.

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