Psychiatric Care Checklist: A Novel Aid to Improve Psychiatric Care in the Emergency Department.

Abstract

Background: Emergency department (ED) patients requiring inpatient psychiatric admission experience prolonged boarding times due to a nationwide deficit in inpatient bed capacity. These extended boarding times, which can last hours to days, introduce additional risks of harm, including missed home medications and omissions in care essential to chronic disease management. The overall aim is to reduce missed care components in ED patients with psychiatric illness awaiting inpatient psychiatry admission by using our novel checklist and mnemonic, sugar control, home medications, expiration time, documentation, social work, and psychiatry consults, coupled with an educational campaign.

Objective: The primary goal of this study was to determine whether the proportion of patients given one or more clinically significant home medications during their ED stay increased after the implementation of the sugar control, home medications, expiration time, documentation, social work, and psychiatry consults checklist and educational interventions.

Methods: We performed a retrospective prepost study to evaluate the sugar control, home medications, expiration time, documentation, social work, and psychiatry consults checklist among patients in the ED awaiting placement in an inpatient psychiatric unit. We implemented our psychiatric care checklist as part of a quality improvement campaign through educational messaging and integration into our intradepartmental transition of care note template.

Results: We utilized electronic medical record data to compare the proportion of patients with psychiatric illness who received more than one clinically significant home medication before and after the implementation of our interventions. A total of 245 patients were included, consisting of 124 patients seen between March 2022 and February 2023 (preintervention period) and 121 patients between March 2023 and February 2024 (postintervention period). The proportion of patients who received at least one clinically significant home medication in the pre-sugar control, home medications, expiration time, documentation, social work, and psychiatry consults intervention period was 46.0% (95% confidence interval: 37.4-54.8%), compared to 58.7% (95% confidence interval: 49.7-67.1) in the postintervention period. This represents a statistically significant increase in the administration of home medications during the intervention compared to baseline (P < 0.05).

Conclusions: This study evaluated the use of a novel psychiatric care checklist in reducing missed home medications in ED patients awaiting inpatient psychiatric admission. The improvement was statistically and clinically significant. Our findings could offer value to other institutions facing significant boarding times for patients with psychiatric illness.