An emergency department is a hospital section meant to respond to patient’s calls at any time of the day. A psychiatric emergency department, therefore, responds to patients with psychiatric emergencies. According to Lofchy et al. (2004), a psychiatric emergency constitutes any acute disturbance in behavior, thought, or mood of a patient, which may harm the individual or those around him if untreated. As such, a major emergency would constitute a situation where a patient’s condition poses a danger to the patient’s life or those around him. On the other hand, a minor emergency would not pose a threat to life but can cause severe incapacitation. Safety measures are critical when dealing with psychiatric emergency departments as seriously ill patients may cause harm to themselves or the hospital staff meant to receive them. The primary safety concern in a psychiatric emergency department is the assessment of suicidal patients.
Assessment of Suicidal Patients
A suicidal patient is at risk of losing their lives and, in other circumstances, harm individuals around him before taking his own life. It is at times difficult to tell whether a person is going to commit suicide. Data from the Centers for Disease Control and Prevention show that suicide cases increased from 10.5 to 13.0 per 100,000 population between 1999 and 2014 (Curtin et al., 2016). Patient visits to psychiatric emergency departments present a chance to dispense life-saving suicide prevention interventions (Asarnow et al., 2017). Patients who visit psychiatric emergency departments as a result of suicide attempts are likely to make another attempt. Asarnow et al. (2017) highlight that a significant number of patients who succumb to suicide made visits to a psychiatric emergency department the year before their death. Assessment of suicidal patients in a psychiatric emergency department is therefore critical to reducing deaths due to suicide.
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It is important to identify suicidal patients in a bit to try and help them. Identifying these suicidal patients is a bit difficult as patients tend to try and hide suicidal thoughts. The Joint Commission (2018) lists identification of patient safety risks in its National Patient Safety Goals. It directs medical personnel to assess which patients present the most likelihood of committing suicide. However, the identification of suicidal patients in a psychiatric emergency department has its challenges.
Patients spend a long time in the emergency department before receiving care. The long wait could easily interfere with hospital staff identification of suicidal patients because they can decide to do self-harm at any moment. Turner et al. (2015) point out that shortages of psychiatric staff and inpatient beds play a part in the long waiting lines found for behavioral health patients. It is also seen that there are restrictions in the health care system, which create new challenges, increase patient fees, and cause frustration which results in youths leaving emergency departments without needed evaluations (Turner et al., 2015). Hospital staff would therefore miss out on an opportunity of identifying suicidal patients.
The setting of emergency departments poses another challenge to identifying suicidal patients. It could hinder the proper provision of emergency services to patients with mental health issues. Emergency departments are frequently crowded and loud and lack privacy (Turner et al., 2015). Patients may be unwilling to discuss personal matters with the staff they recently encountered openly. The presence of other medically and psychiatrically ill patients in the emergency department can also be scary and uncomfortable to psychiatric patients (Turner et al., 2015). The result is that hospital staff do not have adequate information to diagnose patients meaning that they may miss out on self-harm indications by a patient. The open nature of emergency departments allows patients to roam freely, and distinguishing between psychiatric patients and medical patients in an emergency department is challenging (Chou, 2020). There is a danger of psychiatric patients leaving without getting medical attention. Therefore, psychiatric patients with suicidal thoughts would evade identification that would have given them much-needed medical attention.
Even with successful identification, psychiatric emergency departments still face other challenges in their bid to assess suicidal patients. Hospitals have serious reimbursement issues that hamper a hospital’s ability to improve patient flow and guarantee that generated revenue will cover costs (Turner et al., 2015). Patients with mental health issues are most likely suicidal, but they will likely not meet the admission criteria because most insurance companies do not cover their claims. Therefore, psychiatric patients would miss out on treatment because of their financial constraints even though they may be suicidal.
Emergency staff also pose a challenge to the practical assessment of suicidal patients. Their human nature has a significant influence on psychiatric patients. Nurses can have a negative attitude towards psychiatric patients. Research by Chou et al. (2020) shows that emergency department nurses can have fixed notions about the psychiatric patients under their care. Nurses admitted to having overlooked psychiatric patients’ issues because they had predetermined distrust in what a patient said. Psychiatric patients are easily affected by the societal judgment, and as such, they could quickly turn suicidal if they realize the people meant to help them are the same ones who look down upon them.
Appropriate Nursing-Sensitive Outcomes.
Nursing-sensitive outcomes or indicators are a measure of how effective nursing practice is on a patient. They assess the care given to a patient. Nursing-sensitive indicators pinpoint structures of care and care processes that influence care outcomes (Montalvo, 2007) . When assessing suicidal patients in the psychiatric emergency department, various nursing-sensitive outcomes can be employed to evaluate the care and care process these patients receive. The official list provided by NDNQI (2011) is used when selecting appropriate nursing-sensitive indicators. The indicators that apply in evaluating psychiatric patient care include nursing hours per patient day, psychiatric physical or sexual assault, registered nurses survey, registered nurses’ education or certification, nosocomial infections, and nursing turnover rate.
The nursing hours per patient day reflect the structure of care given to a patient. Nursing hours per patient day is the total amount of nurses providing patient care compared to patients. NDNQI (2011) outlines groups whose measurements should be taken when assessing this indicator . These groups include registered nurses, licensed practical or vocational nurses, and unlicensed assistants. Higher numbers indicate better health care. When assessing suicidal patients in a psychiatric emergency department, many nursing hours per patient day imply that suicidal patients get enough attention and get the required help.
Psychiatric physical or sexual assault is a reflection of nursing outcomes. A minimal number of cases of psychiatric physical or sexual assault indicate good patient care. Psychiatric patients can be subject to physical abuse due to the negative attitude portrayed by some nursing staff (Chou, 2020). The quality of care offered to psychiatric patients can be evaluated based on how many physical or sexual assault cases are reported.
Evaluation of patient care cannot be done by evaluating nursing staff alone. The nursing staff can also participate by giving their evaluation of a healthcare system. Registered nurses survey take care of this. NDNQI (2011) requires a registered nurses’ survey to focus on Job Satisfaction Scales and Practice Environment Scale (PES). Through these two scales, nurses can raise any concerns they have about their working environment. Issues faced in a psychiatric emergency department can be identified through this survey. Missing resources can be identified and any other administrative support required by nurses to attend to psychiatric patients.
Intervention Applied
Identification of a problem without looking for a solution is not helpful. Chassin (2014) said that healthcare providers asked his organization to provide solutions instead of highlighting quality problems alone. The safety concern of suicidal patients in psychiatric emergency departments requires an intervention. An intervention that can be applied in the psychiatric emergency department is the employment of a part-time psychiatrist, full-time nurse, and administrative agent. Research by Gabet et al. (2020) shows that patients appreciate the short time spent in the crisis center’s comfortable and friendly environment and their ability to reach clinicians quickly. It becomes easy to offer patients comprehensive treatments, including psychosocial interventions, and adequately explain medication effects.
An evaluation of intervention goes a long way to prove its workability. Testing the intervention in the field would probably generate reliable data. To evaluate how effective the employment of a part-time psychiatrist, full-time nurse, and administrative agent in a psychiatric emergency department will be, we need to implement the intervention in a mental health institution. We will then evaluate results generated from nursing-sensitive indicators and other surveys such as the number of hours per week for each specialist, the number of patients handled, the average number of visits per patient, and the recovery period of successfully treated patients. Gabet et al. (2020) tested this intervention alongside two others in a Montreal psychiatric emergency department of a mental health university institute. The intervention involved 119 patients, 101 of whom responded to the survey. The psychiatrist attended 18 hours a week while the nurse and administrative agent managed 160 patients annually during working hours. Also, patients averaged six visits per patient over 5.5 months. The results showed that eighty-five percent of patients who underwent the intervention a mental disorder diagnosis. During this test period, the medication was managed for 95% of the patients. After discharge, patients were referred to either outpatient services, primary public care, community organizations, or specialized services.
Conclusion
The Joint Commission can recommend the employment of a part-time psychiatrist, full-time nurse, and administrative agent in a psychiatric emergency department in its bid to achieve goal NPSG.15.01.01: Find out which patients are most likely to try to commit suicide. A full-time nurse dedicated to psychiatric patients in an emergency department would easily spot and evaluate each psychiatric patient. Patients would also feel more comfortable talking to a person whose specialty focuses on their problems. Special care of psychiatric patients in the emergency department could also mean that the length of queues reduces. This change might encourage more patients with mental issues to come forward and seek medical care. It could lead to early identification of suicidal patients as their issues would get sorted.
References
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