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Enhancing the use of SMART Tool for the Medical Clearance of Psychiatric Patient in the Emergence Department

SMART Tool for the Medical Clearance of Psychiatric Patient in the Emergence Department

Emergency departments in medical facilities provide opportunities to the working staff to diagnose underlying problems and provide care for psychiatric patients. These patients are always not in the position to receive any other form of assessment, intervention or referral at that particular time and it is the responsibility of the health worker to come up with the best approaches for helping their patients. However, it is disturbing that these emergency departments are always crowded and patients are forced to wait for long before they are attended to or admitted to wards. There is therefore need to emphasize the utilization of the SMART Tool in order to enhance efficiency and reduce delays/waiting time by patients at the facility. The following is basically an outline on ways that will be used in ensuring that the SMART Tool is utilized to the maximum by healthcare providers at the emergency department.

Enhancing the use of SMART Tool for the Medical Clearance of Psychiatric Patient in the Emergence Department

It has been noted that emergency departments in hospitals are the most visited units in the hospital for cases of mental illnesses. Studies show that from 1992 to 2000 mental health visits had increased by about 15%. During this period 5.5 % of these visits were attributed to primary mental health issues. Cases for psychiatric conditions were also much higher than those for non-psychiatric conditions (Rhodes et al., 2008). Most of these increases in the number of visits to emergency departments have been attributed to barriers that have been put into place that restrict outpatient mental health care (Rhodes et al., 2008).

A decline in the number of psychiatric patients in California lead to closure of three state psychiatric hospitals in the 1960s extending to the early 1970s. The result was an introduction of outpatient services for mental related conditions. The move taken by the state government had not involved consultation with other interested parties. It ended up resulting into some of these psychotic patients becoming criminalized in 1972 (Sierra Sacramento Valley Medical Society, 2016).

Sutter Medical Center Emergence Department is also faced with this issue of increased visits by patients with mental problems. However, there are no better strategies on handling this increasing number of visiting patients. This has resulted into problems with clearing patients resulting into an overcrowded emergency department. There is no use of SMART protocol during provision of care to these patients, something that impacts negatively to the quality of health care offered.[“Write my essay for me?” Get help here.]

Statement of the Problem
The SMART Protocol is a tool that enables the care team to assess psychiatric patients in the ED so that they can get the appropriate care and transfer to mental health facility. However, it has come to notice that doctors and nurses working for Sutter Medical Center Emergence Department (ED) are not putting into use the SMART Protocol for medical clearance of psychiatric patients. There are also no current policies put into place to track and monitor the use of SMART protocol at Sutter Medical Center Emergence Department (ED) in Sacramento. This has resulted into overcrowding of the emergency department by patients seeking medical and psychiatric services.

At Sutter Medical Center Emergence Department, the number of mental patients visiting the emergency department has been noted to be on the rise. However, medical staff at this facility has not adopted the use of SMART protocol and so there is extended wait time for both patients experiencing both medical and psychiatric issues. Patients requiring mental health care are boarded in the ED for too long with lower quality care that results in the higher risks of adverse outcomes.

Not employing SMART protocol at Sutter Medical Center Emergence Department has resulted into many avoidable problems at the facility. SMART protocol is known to help care providers in provision of timely and specialized care the different health demands by patients. Mental emergency department should therefore put into practice SMART protocol for faster and better service delivery to their patients and clients. There is therefore the need for adoption and enhancement of use of SMART protocol at Sutter Medical Center Emergence Department to enhance performance.

Goals and Objectives
This project is aimed at promoting the utilization of SMART protocol for medical clearance of psychotic patients and those with any mental health issues at Sutter Medical Center Emergence Department. The project targets boosting utilization of SMART protocol for medical clearance of patients with mental health problems to about 90 % by March 2017. Increased utilization will automatically result into provision of appropriate and improved emergency care to these patients. It will also reduce complaints from patients about waiting time.

Literature Review
Psychiatric patients visiting the emergency department comprise of many mental conditions. Some come with mood disorders, others with mental disorders like schizophrenia while some may be referred to the facility by different authorities. Most of these police referrals involve more male members of the society as opposed to the female and most cases of police referrals are assaultive and comprise of dangerous behavior towards other members of the society. Police department has been known for taking part greatly in some of these referrals. In most countries in the world the police are known for being the first people to be conducted in case one develops a mental disorder. There is therefore need for training on better ways of dealing with or handling these patients (Telle et al., 2006). [Need an essay writing service? Find help here.]

SMART Tool for the Medical Clearance of Psychiatric Patient in the Emergence Department

Studies have shown that psychiatric patients who seek emergency services are different in terms of demography when compared to the rest of the population (Shield et al., 2016). Psychiatric patients seeking emergency medical attention were found to comprise of more men than women. Also, World Health Organization has high scores for psychiatric patients than the other population in terms of assessment and disability assessment. There is therefore need for collection of data on functioning and disability for the psychiatric department. There is also need to have accurate alignment of patients to correct intensity of services offered (Shield et al., 2016).

The emergency department works in collaboration with psychiatric wards in the process of provision of care to its clients. Individuals requiring hospitalization are sent to psychiatric wards after going through the emergency department. There is a possibility of delays during this process of transfer and admission to psychiatric wards if the emergency department is overcrowded. Waiting time before admission to psychiatric wards was found to be 17.9 hours at the emergency department of Queen Elizabeth Hospital situated in South Australia. Waiting time during the weekend was greater than during week days. It was also noted that psychiatric discharges were fewer over the weekends than during weekdays (Bastiampillai et al., 2012). From the study, it was concluded that the long waiting times during the weekends was attributed to fewer discharges from the wards.

Studies have shown that the main reason for psychiatric inpatient admissions were cases of delirium. Admitting psychogeriatric patients into inpatient section of a psychiatric unit is based on several indicators. However, currently there is clear outline of guidelines on what to consider before making decisions on whether to recommend the patient for impatient or outpatient treatment (Tang et al., 2014). Several factors contribute towards decision making on whether to refer a patient for inpatient or outpatient treatment at a psychiatric unit. It is the interactions between this factors that determines the decisions made. Based on these factors, doctors and staff emergency rooms can then make dispositional decisions.

Several predisposing factors have been associated with inpatient admission of psychiatric patients who pay visits to emergency departments. In a study done in some emergency departments of urban areas in the United States showed that ageing was one of the predisposing factors. Arrival by emergency transport coupled by longer length of stay increased the likelihood of hospitalization (Hamilton et al., 2016). Need factors also contributed greatly to the probability of one’s hospitalization. For instance, if one exhibits impulsive control disorder or any diagnosis or history of suicidal ideation, there is an increased the probability of hospitalization and admission for impatient treatment (Hepp et al., 2004).

The older population is known for increased risks when it comes to any health condition leave alone psychiatric conditions. The health care by the older population is unique in cases of disasters. Thus it means that the older population is a more vulnerable group as compared to other groups. When coming up with or implementing any project in the emergency department consideration should be given to the geriatric population. It has been found out that shelter put up for disaster always fail to accommodate the needs of this ageing population. The same is reflected to emergency departments in health facilities. To worsen the situation, the older population is on the rise hence the need for quicker interventions or plans that will help in handling them (Wilber et al., 2006).

Lengths of stay and boarding for psychiatric patients have been subjects of concerns in emergency departments. Overcrowding and the problem of long waiting time in emergency departments have led to studies to examine connection between lengths of stay and boarding in the emergency departments. Such a study was done at Florida emergency departments. In the study it was established that longer length of stay was endemic of psychotic patients at the emergency department. The mean length of stay was found to be 7.77 hours while anxiety related disorder was present in most cases of complaints presented by these patients. Ironically, anxiety related disorders had the lowest mean when it came to length of stay at the emergency department (Smith et al., 2016).

SMART Tool for the Medical Clearance of Psychiatric Patient in the Emergence Department

Several mechanisms have been put up to help in combating these problems of long waits in the emergency department across various countries. Iran, for instance, has come up with the use of queuing theory and simulation modeling (Askarian et al., 2014). In some developed countries, the queuing theory is highly appreciated though there are some other interventions put into place to cushion the problem of staying long in queues. For instance, a study conducted in some of the hospitals in Iran revealed some crucial findings as explored below.

Findings obtained from a cross-sectional study conducted in hospitals with emergency departments in Iran show that about 4088 patients had left the emergency department within the thirty days of study. It also indicated that doubling of bed capacity that was done in hospitals helped greatly in reducing number of patients waiting to the discharged at the wards. While 1238 patients were still on the queue waiting, the number of beds in the ward was doubled from 81 to 179 something that helped reduce the number of waiting patients to almost 500 (Askarian et al., 2014).

Smooth transitions from the emergency department to the bed section in the ward is one of the objectives when coming up with or implementing plans to curb the problem of overcrowded emergency departments. Reduction in bed number in the emergency department has been found to reduce length of stay of psychiatric patients. It also reduces the number of referrals received from the community. Waiting times at the emergency department before transfer or admission to the bed section is also reduced through this. A study was therefore carried out on the impact of closure of psychiatry inpatient services through reduction of bed numbers.

The study was done at Cramond Clinic of Queen Elizabeth Hospital and involved comparing change in services within three years. 2006-2007 was the baseline period since bed reduction was not yet been done. 2007-2008 was the observation period since bed reduction had occurred and 2008-2009 was the intervention year. Findings from the study indicated that reducing the number of beds while adopting another new care procedure or intervention would result into better care provision. As observed in this study, the reduction in number of beds was catered for improved and better training to the staff to ensure efficiency (Bastiampillai et al., 2012).

Australia has not been spared with this problem of long waiting times and overcrowding at the emergency department. There has been an outcry and discussions on the need to come up with measures aimed at reducing time spent waiting in the emergency department. From a study that was conducted on the impact daily discharge in the psychiatric department had on the emergency department, it was found that the number of patients discharged during weekends was fewer than those discharged during weekdays. The study involved retrospective analysis of patient flow at an emergency department at Queen Elizabeth Hospital in terms of number of patients waiting for admission and those discharged (Bastiampillai et al., 2012).

Time spent in the emergency department by patients waiting to be admitted to the psychiatry ward during was found to be 17.9 hours a figure higher than the targeted 4 hours. Waiting times before admission on weekdays were found to be less than waiting times during weekends. This inverse correlation meant that waiting time reduces with an increase in the number of those discharged. It was also found that patients requiring emergency care were more on weekdays than during weekends something that was attributed to work practices in terms of psychiatric evaluation at their places of work (Bastiampillai et al., 2012).

Computer information systems prove very essential in times of dilemmas and emergencies in organization and even hospitals (There is therefore need for emergency departments to install this computerized technology to allow for easy information linkages and performance of complicated operations. California adopted one of this programs which they termed as CHIPS that was started in 1965 with an aim of satisfying the needs of health facilities planning (Buntin et al., 2011).

Stakeholders and Collaborative Partners
Implementation of this project will largely depend on the collaboration of emergency department staff members and other staff, such as those from the psychiatric evaluation department, at the facility. The crucial stakeholders for this project include Director and Chief Executive Officer of Mental Health Care Services, Directors of the Emergency Department, Emergency Department Management Supervisor and Psychiatric Evaluation Team (PET) Manager. Established collaboration among stakeholders and involved staffs will the determinant and a boost for the project’s success.[Click Essay Writer to order your essay]

Methodologies that will be employed in this project will include recommendations by the Sierra Sacramento Valley Medical Society (2015). This would include establishment of dedicated psychiatry emergency services which will ensure for timeliness in care provision for these patients.
In order to enhance coordination in the process of patients in the emergency department, there will be need for installation of electronic technology to allow for exchange of health information among the staff members. Clearance process in all the other emergency departments will also be standardized to ensure quicker and timely patient transfer among departments and treatment centers.

SWOT analysis during the progress of the project will also be performed. This will involve analysis of the strengths, weakness and other variables to help in anticipating, improving and supporting outcomes. EPIC and self- administered questionnaires will be fundamental for information gathering during the study.

Evaluation on the progress and success will be achieved through making comparisons on baseline data with interim and final data. This project being set to run till March of 2017, will allow for incorporation of other benchmarks in evaluating the frequency and quality of improvements of SMART protocol. Service delivery during this period will also be evaluated. Pre and post tests will also be used to test the impact the utilization of SMART protocol has brought on quality of health care to these patients.

Both qualitative and quantitative tools of evaluation will be used during the evaluation. Health care being an intangible commodity, surveys, observations, interviews and case studies will be applied to determine client’s views on service delivery after and before utilization of SMART protocol.

Maintain collaboration between stake holders and staff from the emergency department and the psychiatric evaluation department. . Similarly, collection and review of data should be ongoing to ensure sustainability. SWOT analysis should go on throughout the process to allow for improvement in outcomes. There is need for training on the importance of SMART protocol among the staff members at the center.

Solution to the problem of overcrowding and long waiting times at Sutter Medical Center Emergence Department could be achieved through the utilization of SMART protocol. With no staff member employing the use of SMART protocol, planning and timing of events during events of patient care becomes a problem. There is also no coordination between the emergency department and the psychiatric wards making patients wait for a long time before getting admitted into the ward. Therefore, if the implementation of this project comes to pass before March 2017 there will be many improvements at Sutter Medical Center Emergence Department.


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By Hanna Robinson

Hanna has won numerous writing awards. She specializes in academic writing, copywriting, business plans and resumes. After graduating from the Comosun College's journalism program, she went on to work at community newspapers throughout Atlantic Canada, before embarking on her freelancing journey.

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