The rise in adult substance abuse has put stress on some hospitals and psychiatric inpatient facilities. With, an increasing number of patients in need of treatment for mental health and substance-related illnesses one hospital’s emergency department experienced an influx of new patients. This combined with a lack of resources to treat psychiatric and substance abuse related conditions caused the caregiving and decision-making functions in the emergency department related to that type of patient to deteriorate.
This outcome led to investigations related to several serious security-related incidents, inadequate safety practices related to behavioral health patients and an increasing number of patients presenting with mental/behavioral health conditions that were being held in the ED for long periods without reassessment and treatment.
The problems uncovered by the patient safety and risk consultant safety initiative included:
- Lack of staff training in non-violence intervention/lack of security;
- No suicide risk assessment performed on behavioral health patients in the ED;
- Staff members did not feel comfortable escalating safety concerns;
- Unsafe conditions in behavioral health holding rooms;
- Holding behavioral health patients for long periods with inadequate ongoing treatment and evaluation;
- Failure to perform medical screening exam on all behavioral health patients (in violation of EMTALA law); and
- History of EMTALA investigations; potential for fines/penalties.
The consultant made the following recommendations to the hospital and emergency department:
- Develop a performance improvement team to address recommendations;
- Implement a comprehensive workplace violence program;
- Implement a suicide screening assessment in the emergency department;
- Review and revise contradictory policies and procedures; and
- Educate staff on the importance of invoking the chain of command to address patient safety and compliance issues.
Though the emergency department was not built to treat behavioral health patients, it’s important for hospitals and healthcare systems to regularly evaluate their patient population, and respond accordingly.
As a member of the National Patient Safety Foundation Patient Safety Coalition, MagMutual is an active participant in Patient Safety Awareness Week. Find out more.
The risk management advice presented in this Site is intended as general information of interest to physicians and other healthcare professionals. The recommendations and advice published on this Site do not reflect or establish a standard of care and do not establish rules for the practice of medicine. The publication of this information is not intended as an offer to insure such conditions or exposures, or to indicate that MAG Mutual Insurance Company will underwrite such risks for the reader. Our liability is limited to the specific written terms and conditions of actual insurance policies issued.