Monday, July 11, 2022

Planning Around Patient Strengths Can Reduce Emergency Department Stays for Psychiatric Problems

A safety planning framework that focuses on one’s strengths can improve the outcomes of patients admitted to an emergency department (ED) with psychiatric distress, reports a study in Psychiatric Services in Advance.

“Previously, the approach to risk management was restrictive and focused on patient deficits,” wrote Manaan Kar Ray, M.R.C.Psych., of Princess Alexandra Hospital in Brisbane, Australia, and colleagues. An innovative approach called PROTECT, however, draws on the patient’s strengths and means of personal support to create the self-belief that suicidal urges can be overcome.

The PROTECT framework has hospital staff engage in semistructured conversations with psychiatric patients to help them prepare for three time points after discharge:

  • One hour: Staff and patients discuss practical issues related to leaving the hospital, such as how the patients will get to where they will be staying, what might await the patients in such settings, and whether they have what they need for this transition (charged cell phone, wallet, follow-up appointments, and/or medications or prescriptions).
  • Two days: Staff and patients discuss the patients’ short-term needs and goals, such as access to food, shelter, and money; with whom the patient will spend time; and what activities they have planned.
  • Seven days: Staff and patients explore potential risk factors for distress that patients may face and how these risks might be mitigated.

PROTECT was implemented in Princess Alexandra Hospital (PAH) in December 2019. Kar Ray and colleagues compared the pre- and post-implementation ED data of PAH with a comparable hospital in Queensland that did not use PROTECT.

They found that 13 months after implementing PROTECT, the average length of stay for patients with psychiatric distress dropped from 17.3 to 8.6 hours, while the number of patients who stayed in the ED for more than 24 hours dropped from 24% to 6%. In addition, the number of patients who were transferred directly to inpatient care dropped from 23% to 18%. None of these statistics changed significantly at the comparator hospital over the 13-month period.

This intervention “can unlock patients’ potential to manage their safety and help them reconnect with hope at a time when hope is dwindling,” the authors wrote. “This outcome mitigates clinical risk and reduces [average length of stays] and may enhance patients’ experiences, which could improve future treatment engagement and early help seeking.”

For related information, see the Psychiatric Services article “Feasibility of Peer-Delivered Suicide Safety Planning in the Emergency Department: Results From a Pilot Trial.”

(Image: iStock/MJFelt)


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