- A new ECRI Institute report identifies gaps in managing the care of acute care patients with behavioral health needs and issues recommendations to help hospitals meet those needs.
- The nonprofit patient safety organization analyzed 2,364 event reports involving patients with behavioral health needs in general acute care settings. Of those, 1,072 took place in an inpatient nonpsychiatric unit, 782 in the emergency department, 197 elsewhere in the facility and 23 following discharge.
- More than half of the events involved patient violence against others. Communication challenges, particularly between patient and staff, was the most common contributing factor, showing up in 318 events.
Nearly one-fifth of adults (18%) had a diagnosable mental illness in the past year, according to the National Institute of Mental Health, creating huge demand for behavioral health services. In acute care hospitals, more than 40% of stays for a physical condition also involve a mental or substance abuse disorder.
A Milliman research report blamed delays and avoidance of behavioral care for $406 billion in additional healthcare costs in 2017. While nearly 30% of adults with physical health conditions have comorbid mental health issues, integration of behavioral and primary care services has been slow to occur. As a result, many cases go undiagnosed and untreated until patients present in the ED or inpatient ward.
"Behavioral health issues have been one of our top 10 patient safety concerns for the past three years," William Marella, ECRI Institute's executive director of PSO operation and analytics, said in a statement. "Our close work with healthcare providers identifies flashpoints in care delivery and highlights patient needs that often aren't met."
For example, organizational and staff response to behavioral health events tended toward security intervention and use of restraints rather than psychiatric evaluation and transfer to psychiatric treatment.
To close these gaps, health systems and C-suite leaders need to have a vision for meeting behavioral health needs of acute care patients, the report says. That should be followed by questions, such as what processes are in place for recognizing and planning for patients' behavioral health needs and which provider and staff competencies need to be strengthened in this area.
Organizations and staff should also be familiar with laws and regulations related to behavioral health and review their effectiveness at working with the community and outside providers to coordinate care in appropriate settings.
Other improvement strategies include use of evidence-based guidelines on behavioral health topics, analyzing utilization patterns to identify barrier to behavioral health services, clinician training and partnering with local groups and agencies to address social determinants of health.