Evaluating Safety Concerns for Pediatric Mental and Behavioral Health Patients and Providers in the Emergency Department: A Systems Perspective.

Abstract

Objective: The objective of this study was to determine key issues related to the safety of pediatric mental and behavioral (MBH) patients in the emergency department (ED), as well as related provider safety issues from a systems perspective.

Methods: Semistructured interviews were conducted with 55 staff members from 4 ED units in rural and urban hospitals. Utilizing the Systems Engineering Initiative for Patient Safety framework, interviews were coded in Atlas.ti for physical environment, tasks, roles, technology, organization, and safety.

Results: Self-harm, harm to others, and elopement were the frequently mentioned safety concerns. The type of ED (general adult, non-MBH unit) and presence of ligatures in patient care areas increased risks to patient safety. ED layout, patient visibility, and proximity to exits increased elopement risks. The ED environment was seen as a trigger for patient agitation, exacerbating MBH conditions. Major challenges in safety incident prevention and response included inadequate pediatric de-escalation training and ineffective use of protective shields. Technological barriers affecting safety encompass issues with the accessibility and reliability of panic buttons.

Conclusions: The study calls for a comprehensive approach to safety in the ED, integrating organizational policies, environment design, technology use, staff training, and resource management, setting the stage for future enhancements in safety for both pediatric MBH patients and health care providers.