A new study in The Joint Commission Journal on Quality and Patient Safety, “Keeping Patients at Risk for Self-Harm Safe in the Emergency Department: A Protocolized Approach,” by Abigail L. Donovan, MD, and colleagues at Massachusetts General Hospital, Boston, describes the implementation of a comprehensive safety precautions protocol for emergency department (ED) patients at risk for self-harm, announced the commission.
ED boarding of patients with psychiatric illness is a critical issue. These patients are twice as likely as medical patients to require inpatient admission and five times more likely to board (waiting for more than a set number of hours – often four hours – for an inpatient bed).
A multidisciplinary team developed the protocol to include several comprehensive safety precautions, including:
· Creating safe bathrooms
· Increasing the number and training of observers
· Managing access to belongings
· Managing clothing search or removal
· Implementing additional interventions for exceptionally high-risk patients
The researchers measured events of attempted self-harm for 12 months before and after the new safety precautions were enacted.
Findings showed in the 12 months prior to the protocol initiation, among 4,408 at-risk patients, there were 13 episodes of attempted self-harm (2.95 per 1,000 at-risk patients) and six that resulted in actual self-harm (1.36 per 1,000 at-risk patients). In the 12 months after the protocol was introduced, among 4,523 at-risk patients, there were 6 episodes of attempted self-harm (1.33 per 1,000 at-risk patients) and only one that resulted in actual self-harm (0.22 per 1,000 at-risk patients).
The researchers conclude that comprehensive safety precautions can be successfully developed and implemented in the ED and stress the importance of including multidisciplinary staff in the development of the safety precautions protocol.
“We commend the use of a multidisciplinary approach to improve ED behavioral health processes and focus on a team-based methodology for patient safety, protocol development and education,” adds an accompanying editorial by Scott Zeller, MD and Seth Thomas, MD. “This recommended collaboration parallels recent best-practice guidelines for behavioral health patients in EDs as crafted by the Institute for Healthcare Improvement and the Emergency Medicine Council.”
