A Multidisciplinary Initiative Improves Care for Psychiatric Patients Boarding in the Emergency Department

Area of Science:

• Emergency Medicine
• Psychiatric Care
• Quality Improvement

Background:

• Emergency departments (EDs) face significant challenges in managing psychiatric patients.
• Prolonged boarding times and delayed treatment are common issues.
• There is a need for improved efficiency and resource utilization in psychiatric emergency care.

Purpose of the Study:

• To implement and evaluate a multidisciplinary quality improvement initiative.
• To enhance the care of psychiatric patients within the ED setting.
• To reduce ED boarding times and improve patient outcomes.

Main Methods:

• A single-institution quality improvement initiative was conducted.
• A multidisciplinary team approach was employed.
• Focus was placed on improving efficiency and resource use for psychiatric patients.

Main Results:

• Time to triage decreased by 23% (30 to 23 minutes).
• Patients leaving without treatment decreased from 6.5% to 4.2%.
• Time to medication for agitation reduced by 24.9% (3.0 to 2.2 hours).
• ED boarding time for admitted patients decreased by 10.9%.
• Physical restraint use and total restraint time decreased significantly.
• ED length of stay for discharged patients increased slightly (9.9%).

Conclusions:

• Structured, team-based interventions can significantly improve psychiatric emergency care.
• The initiative demonstrated improvements in key performance metrics.
• Results showed variable sustainability at the 2-year follow-up.