Utilizing a Behavioral Health Bundle to Improve Patient and Clinician Safety for Hospitalized Children

Area of Science:

• Pediatric healthcare
• Behavioral health integration
• Patient safety

Background:

• Increasing numbers of pediatric patients with behavioral health needs are hospitalized in medical units due to limited psychiatric bed availability.
• This situation places patients and staff at increased risk for safety events, including self-harm and aggression.
• Existing hospital environments pose risks for children requiring behavioral health care.

Purpose of the Study:

• To decrease safety events by 25% over one year in hospitalized children with behavioral health diagnoses.
• To evaluate the impact of a bundled intervention on patient safety and care coordination.
• To address the challenges of managing pediatric behavioral health patients in medical units.

Main Methods:

• Implementation of a behavioral health intervention bundle including a BH equipment cart, EMR tool for patient identification, a de-escalation team, and staff training.
• Utilized a multidisciplinary team approach for development and implementation.
• Primary outcome: number of safety events in BH patients; Process measure: medically avoidable days; Balance measure: staff workflow perception.

Main Results:

• A downward trend in safety events was observed (28% decrease), though not statistically significant.
• No special cause variation was achieved for safety events or medically avoidable days.
• Staff feedback was mixed: one-third found the bundle helpful, while many reported workflow impediments and discomfort.

Conclusions:

• Implementing a behavioral health intervention bundle requires substantial institutional support and interdisciplinary collaboration.
• Measurable improvements in patient safety and care coordination were not achieved despite the intervention.
• Further studies are necessary to determine the impact and enhance care for pediatric patients with behavioral health needs in medical settings.