A Qualitative Assessment of Barriers and Proposed Interventions to Improve Acute Agitation Management for Children With Mental and Behavioral Health Conditions in the Emergency Department

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-03-01 DOI:10.1016/j.jaclp.2023.12.001
Jennifer A. Hoffmann M.D., M.S. , Anisha Kshetrapal M.D., M.S.Ed. , Alba Pergjika M.D., M.P.H. , Ashley A. Foster M.D. , Julia H. Wnorowska R.N., B.S.N. , Julie K. Johnson M.S.P.H., Ph.D.
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Abstract

Background

Mental health visits to the emergency department (ED) by children are rising in the United States, and acute agitation during these visits presents safety risks to patients and staff.

Objective

We sought to assess barriers and strategies for providing high-quality care to children who experience acute agitation in the ED.

Methods

We conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. Interviews were coded and analyzed thematically.

Results

Participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities.

Conclusions

Understanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.

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定性评估急诊科对患有精神和行为健康问题的儿童进行急性躁动管理的障碍和干预建议
背景在美国,儿童到急诊科(ED)就诊的人数不断增加,而就诊期间的急性躁动给患者和工作人员带来了安全风险。方法我们对 6 名急诊科医生、6 名急诊科护士、6 名家长和 6 名躁动高危青少年进行了半结构式访谈。我们询问了参与者在急诊室急性躁动护理方面的经验、提供高质量护理的障碍和促进因素以及建议的干预措施。结果参与者讨论了识别急性躁动的风险因素、担心安全和受伤风险、感到精神痛苦以及向以患者为中心、创伤知情护理的文化转变等问题。障碍和促进因素包括使用标准化护理路径、识别环境障碍和分配资源、与家庭和儿童合作以及团队成员之间的沟通。提出了九项干预措施:开设行为观察室并配备专门人员和空间、提出筛查问题以确定躁动风险、在电子病历中创建个性化护理计划、使用标准化躁动严重程度量表、实施行为反应小组、提供安全活动和环境改造、改进交接流程、教育员工以及解决偏见和不平等问题。在设计改善护理的干预措施时,应考虑家属和患者的观点。
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来源期刊
CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
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