Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently...

Area of Science:

• Healthcare Management
• Quality Improvement
• Patient Safety

Background:

• Hospitalized patients with co-occurring medical and psychiatric conditions face poorer outcomes.
• Healthcare providers are at higher risk of workplace violence when caring for this population.
• A dedicated clinical microsystem is needed for patients too medically ill for psychiatric units and too psychiatrically ill for medical units.

Purpose of the Study:

• To evaluate the impact of a specialized clinical microsystem on patient and staff safety.
• To assess improvements in operational outcomes for patients with complex medical and psychiatric needs.
• To understand the effects of a co-managed medicine-psychiatry unit.

Main Methods:

• A quality improvement study was conducted at an urban academic medical center.
• A medicine-psychiatry co-managed clinical microsystem was implemented, emphasizing high-performance teamwork.
• Poisson regression analyzed differences in workplace violence, falls, 30-day emergency department (ED) revisits, and readmissions between baseline and intervention periods.

Main Results:

• Workplace violence events decreased by 65.6% post-intervention (IRR 0.34, p < 0.001).
• 30-day ED utilization post-discharge decreased from 30.6% to 21.0% (aOR 0.60, p = 0.006).
• No significant differences were observed in falls or 30-day readmissions.

Conclusions:

• A clinical microsystem integrating environmental and teamwork changes can reduce workplace violence.
• This integrated approach improves post-discharge emergency department utilization for complex patients.
• The model demonstrates effectiveness in enhancing safety and operational outcomes for a vulnerable patient group.