title: Use of a Dedicated, Non-Physician-led Mental Health Team to Reduce Pediatric Emergency Department Lengths of Stay.
abstract: OBJECTIVE
  Utilization of emergency departments (EDs) for pediatric mental health (MH) complaints is increasing. These patients require more resources and have higher admission rates than those with nonpsychiatric complaints.
  
  
  METHODS
  A multistage, multidisciplinary process to reduce length of stay (LOS) and improve the quality of care for patients with psychiatric complaints was performed at a tertiary care children's hospital's ED using Lean methodology. This process resulted in the implementation of a dedicated MH team, led by either a social worker or a psychiatric nurse, to evaluate patients, facilitate admissions, and arrange discharge planning. We conducted a retrospective, before-and-after study analyzing data 1 year before through 1 year after new process implementation (March 28, 2011). Our primary outcome was mean ED LOS.
  
  
  RESULTS
  After process implementation there was a statistically significant decrease in mean ED LOS (332 minutes vs. 244 minutes, p < 0.001). An x-bar chart of mean LOS shows special cause variation. Significant decreases were seen in median ED LOS (225 minutes vs. 204 minutes, p = 0.001), security physical interventions (2.0% vs. 0.4%, p = 0.004), and restraint use (1.7% vs. 0.1%, p < 0.001). No significant change was observed in admission rate, 72-hour return rate, or patient elopement/agitation events. Staff surveys showed improved perception of patient satisfaction, process efficacy, and patient safety.
  
  
  CONCLUSIONS
  Use of quality improvement methodology led to a redesign that was associated with a significant reduction in mean LOS of patients with psychiatric complaints and improved ED staff perception of care.
authors.affiliation: The Department of Pediatrics Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA.|The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Neil G
authors.initials: NG
authors.lastname: Uspal
authors.affiliation: The Department of Pediatrics Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA.|The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Lori E
authors.initials: LE
authors.lastname: Rutman
authors.affiliation: The Department of Psychiatry, University of Washington, Seattle Children's Hospital, Seattle, WA.|The Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Ian
authors.initials: I
authors.lastname: Kodish
authors.affiliation: Psychiatry and Behavioral Medicine, Seattle Children Hospital, Seattle, WA.
authors.forename: Ann
authors.initials: A
authors.lastname: Moore
authors.affiliation: The Department of Pediatrics Division of Emergency Medicine, University of Washington, Seattle Children's Hospital, Seattle, WA.|The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Russell T
authors.initials: RT
authors.lastname: Migita
mesh_terms: D000293:Adolescent; D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D010351:Patient Discharge; D011568:Psychiatric Nursing / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D012189:Retrospective Studies; D000068217:Social Workers; D062606:Tertiary Care Centers / Q000458:organization & administration; D013997:Time Factors