By Stacey Kusterbeck
The pediatric mental health crisis is No. 1 on ECRI’s top 10 patient safety concerns for 2023.1 “The ED is a direct route for patients to go when they are exhibiting symptoms of mental health distress. There are a number of concerns to address when ensuring safety of these patients,” says Andrew Furman, MD, MMM, FACEP, vice president of clinical evidence and safety solutions at ECRI. The ED assessment should include appropriate triage: screening for harm of self or others, a thorough assessment, and consideration of social determinants of health, Furman says. Other safety concerns that are highly relevant to the ED in the ECRI report include:
• Physical and verbal violence against healthcare staff. “No amount of workplace violence should be accepted as ‘part of the job.’ We need a culture shift to support that,” Furman says.
ECRI recommends establishing a zero-tolerance policy that extends to all who come in contact with organizational personnel, clearly communicating patient and visitor codes of conduct, and using a behavioral rapid response team of trained individuals. “Ensure that employees know when and how to activate this team,” Furman recommends.
EDs also can offer training for prevention, early recognition, management, and de-escalation of violent situations through simulation drills on various scenarios. “Build relationships with law enforcement and organizational security personnel, and involve them in simulated drills,” Furman suggests.
• Delayed identification and treatment of sepsis. “ED leaders should be at the table to develop organizational sepsis treatment safety goals,” Furman urges.
ED sepsis outcomes should be included in the organizational assessment of sepsis treatment and management effectiveness, according to the ECRI report. “Integrate sepsis diagnostic tools into the ED clinical workflow,” Furman adds. “The process should require minimal technical expertise from staff to process samples and interpret test results.”
• Poor care coordination for patients with complex medical conditions. Using EDs for complex conditions can lead to unnecessary testing and treatments, risk of polypharmacy, and poor transitions of care. Emergency providers should conduct a thorough medication reconciliation, provide patients with access to chronic disease patient navigators, and practice closed-loop communication with primary care physicians and specialists in the outpatient setting.
In the inpatient setting, says Furman, “EDs should collaborate with case managers and social services to improve care coordination.”
REFERENCE
The pediatric mental health crisis is No. 1 on ECRI’s top 10 patient safety concerns for 2023.
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