Standardizing Medical Clearance of Behavioral Health Patients: Implementation and Evaluation of Adapted SSVMS SMART Form at a Rural Community Hospital Emergency Department
Standardizing Medical Clearance of Behavioral Health Patients: Implementation and Evaluation of Adapted SSVMS SMART Form at a Rural Community Hospital Emergency Department
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2023-05-17
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Sedig, Megan Elizabeth Barter
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Hensley, Patricia
Daub, Katharyn
Daub, Katharyn
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The number of inpatient psychiatric beds has decreased by over 500,000 beds since the 1950s. This has led to many patients seeking mental health care through emergency departments (ED) and a high percentage of ED hours are utilized by patients experiencing mental and/or behavioral crises, in turn leading to overcrowded EDs across the country. The Sierra Sacramento Valley Medical Society (SSVMS) implemented the SMART Form in 2015 to standardize and assist ED providers with the process of ‘medical clearance’ of mental/behavioral health patients. SSVMS SMART Form use led to a 14.9% decrease in ED length of stay (LOS). In the current study, the SMART Form was adapted for use in a rural hospital to evaluate effects on ED LOS, number of blood draws, and number of ancillary tests ordered. Other metrics evaluated were the utilization rate of the SMART Form and staff satisfaction. During the one-month implementation period, it was found that the adapted SMART Form was not utilized, yet staff satisfaction with measures regarding ED workflow, communication between the ED and BHU, and the ED LOS of patients admitted to the BHU shifted from a dissatisfied position to a neutral position. Future steps to continue to improve staff satisfaction measures would be to require that the adapted SMART Form be completed prior to ordering psychiatric consults, evaluating if the SMART Form reduces length of time for patients with a mental and/or behavioral chief complaint to be evaluated by psychiatry, and continuing to assess how increased hospital census affects both departments to develop creative solutions to address increased LOS.
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