Standardized Sign-Out Forms Improve Transition of Care of Emergency Department Psychiatric Boarding Patients

From the 2019 HVPAA National Conference

Dr. Ashley Deutsch (Baystate Medical Center – University of Massachusetts Medical School)

Background

Emergency Department (ED) boarding of patients awaiting inpatient psychiatric placement has increased. It is well established that transition of care is a time when errors can be made resulting in poor patient care.  Recently, our ED implemented a standardized sign-out form to be completed by the initial treating physician that is given to subsequent physicians during transition of care aimed at reducing errors and better caring for patients while awaiting psychiatric placement.

Objective

This study aims to evaluate whether ED physicians felt these forms had a positive impact on the care of boarding psychiatric patients.

Methods

A cross sectional survey was created to evaluate ED physicians’ perceptions of the impact of the sign out initiative on clinical management of boarding psychiatric patients. All full time ED attending physicians at Baystate Medical Center were invited to complete the survey.  Respondents were asked if they felt the following aspects of care were changed since implementation: patients getting home medications ordered, addressing abnormal lab values, HCG testing on appropriate patients, glycemic control in diabetic patients, and overall care of patients awaiting inpatient psychiatric placement. Survey responses were anonymous and included open text for physicians to provide suggestions for improvement. Simple descriptive statistics were used for analysis.

Results

22 of 28 eligible ED physicians responded to the survey (78.6% response).  Overall, 91% or respondents felt that implementation of the sign-out initiative led to improvements in the care of patients awaiting psychiatric placement. Specifically, 86% of respondents identified higher frequency of home medication ordering, and 70% identified that abnormal labs were being addressed more frequently. Additionally 64% stated that HCG testing was completed more often and 86% of respondents felt diabetic patients had improved glycemic control during their ED boarding.

Conclusion

ED physicians felt that implementation of a standardized sign-out initiative for patients awaiting inpatient psychiatric placement improved overall care in the areas of home medication ordering, glycemic control, and appropriate follow up of important laboratory values.

Clinical Implications

Results suggest an opportunity for institutions caring for psychiatric boarding patients to improve transitions of care by using standardized sign out forms that address the most common safety hazards for this patient population.

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