Date of Award

8-2017

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Andrea C. Bostrom

Second Advisor

Karyn Butler

Third Advisor

Dorotha Hoffman

Abstract

Leadership and staff at a rural Critical Access Hospital (CAH)have identified the need for interventions to address the specific care issue of behavioral health patients presenting to the emergency department (ED). The ED has experienced a higher than expected number of visits, which has presented the department with challenges, especially in finding placements for patients who need inpatient treatment. ED management and staff have reported many patients have experienced long lengths of stay in the ED while waiting for beds.

A needs assessment attempts to identify characteristics of patients who remain in the ED for extended lengths of time, and the hospital and systems factors associated with these incidences. A key part of this needs assessment was identifying delays in throughput experienced by behavioral health patients.

ED records for visits that took place within a13 month period were reviewed, including a total of 519 records. Three variables were identified as being associated with increased length of stay.These were whether or not patients were screened by a Community Mental Health (CMH) social worker; whether or not law enforcement was involved with the patient encounter; and whether or not the patient was dispositioned to inpatient behavioral health treatment.

Information obtained during the needs assessment was used to inform the creation of a quality improvement tool for the purpose of continued data collection.

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