(photo by Erin O. Smith)
Over the past decade, Monroe Carell Jr. Children’s Hospital at Vanderbilt has seen rising rates of behavioral and mental health-related visits to the emergency department. This resulted in an increase in behavioral health boarding, which means patients wait in general inpatient units or the emergency department for psychiatric placement.
In 2022, Monroe Carell established a Behavioral Health Taskforce to consolidate and lead work using quality improvement processes. Members are made up of clinical and quality improvement leaders, a project manager, and an executive sponsor. The group meets regularly to discuss new and existing initiatives and ensure progress remains supported throughout the organization.
Recognizing the need for clear communication across services and disciplines, twice daily behavioral acuity huddles involving frontline staff from nursing, social work, child life, psychiatry, psychology, and hospital medicine were developed to allow for real-time problem solving and improved communication.
The huddle allows for a review of patient needs to assist in improving situational awareness, support proactive planning, and help teams anticipate challenges during shift changes and overnight hours in a more efficient manner rather than reviewing retrospectively.
“We have been very deliberate in our actions,” said Heather Kreth, PsyD, associate professor and director of Acute Behavioral Health Services at Monroe Carell. “We were able to develop and refine workflows, communication practices and strategically place expert staff across our pediatric enterprise to make sure we are doing as much as possible to provide individualized care for patients and improve safety.”
The changes resulted in significant benefits, including a reduction in behavioral health boarding admissions by 78%, shortened length of stay by more than 50% and reduced restraint utilization by 67%.
“Creating a robust structure to align multiple departments and disciplines across emergency, inpatient, perioperative, and ambulatory services has been essential in collaboratively improving the care we provide to our patients with mental and behavioral health needs,” said Ashley Ried, MMHC, BSN, RN, Magnet program director, Monroe Carell.
In 2023 Monroe Carell introduced two efforts focused on reducing patient behavioral de-escalation: the Behavioral Emergency Support Team (BEST) and the integration of a board-certified behavior analyst (BCBA) into huddles and inpatient and emergency care. The BEST Team responds to acute patient behavioral events in the inpatient and emergency room settings to provide de-escalation.
In particular, the introduction of a BCBA has offered incredible gains in staff safety and patient care. BCBA provides real-time consultation across units, helping teams adapt care, adjust routines, and implement individualized behavioral strategies as well as train teams on safe and compassionate care for neurodiverse patients.
“If you’re talking about behavioral interventions that can be targeted for severe problem behaviors, that really does benefit from someone with true expertise in behavior and intervention,” said Kreth. “Our BCBA is making a significant impact on the care of kids.”
The Children’s Hospital Association (CHA) recently recognized Monroe Carell for these enhancements with an invitation to present at the CHA Annual Leadership Conference and an article on the new care model.
Standardizing behavioral health care that aligns teams around standard tools, real-time communication and specialized expertise proved to have a significant impact on patient care and safety, staff confidence and system efficiency.
“If you’re trying to do things in isolation with kids across different teams and nobody is talking to each other, things are going to fall through the cracks,” said Kreth. “This group makes sure everyone has a voice in behavioral health care and we keep this work moving forward.”
