UMass Memorial Medical Center (UMMMC) identified a gap in an effective system to identify, plan, and coordinate care for pediatric behavioral health patients who board in the hospital, as they have complex needs behaviorally and/or socially. These patients experience an increased length of stay (LOS), which ultimately has resulted in patients, caregivers, and families experiencing harm and/or negative outcomes. During this project, representatives from all pediatric care areas within UMMMC addressed some of the challenges associated with delivery of care for the identified population, with the goal to ultimately decrease patient length of stay and improve patient and staff safety.
Problem: UMMMC experiences an influx of pediatric behavioral health patients >4 and <19 years old, who board in the hospital for >5 days after medical clearance due to their complex behavioral and/or social needs. The organization lacks an effective system to address the challenges associated with caring for this vulnerable population.
Measurement: By the end of FY2024, goals include reducing:
- The average LOS for population by 20%-the average number of caregiver harm incidents related to patient aggression by 20%
- The average number of patient incidents of harm/aggression by 10%An electronic Pediatric Behavioral Health Dashboard was created to monitor goal progress.
Analysis: Average LOS, average caregiver harm incidents, and average number of patient harm/aggression incidents for FY2023 were compared to the same data during the implementation process. The results measurement will continue through the end of FY2024.
Implementation: Key representatives from all major pediatric care areas determined the following interventions: a screening tool to earlier identify patients at risk for long LOS, creation of patient specific de-escalation/safety plans accessible across care areas, implementing a trauma informed care model, and building a pediatric behavioral health rapid response team (PBHRRT).
Results/Discussion: UMMMC created a long LOS screening tool in the medical record. A subsequent de-escalation/safety plan is completed, and a patients’ individualized plan is accessible regardless of patient location. Trauma informed care curriculum is being rolled out across pediatric care areas. The PBHRRT is anticipated to be live starting 3/2024.
