Kenneth Duckworth, MD, medical director at Vinfen Corporation in Boston, recalls the frustration he felt when inpatient hospital staff would release his psychiatric patients without contacting him. The lack of communication often led to gaps in his patients’ records and left him scrambling to learn more about the circumstances of the hospitalization.
Those experiences are among the reasons Dr. Duckworth, a triple-board-certified psychiatrist and medical director of the National Alliance on Mental Illness (NAMI), was pleased to hear The Joint Commission had released its Hospital-Based Inpatient Psychiatric Services, or HBIPS, measure set. And he’s not alone. HBIPS provides standardized measures for psychiatric services where previously none existed, and it gives hospitals the ability to use their data as a basis for national comparison.
Ann Watt, associate director, division of quality measurement and research at the Joint Commission, says although it’s still early, the measures seem to be working. “While we don’t have any actual data, we have received positive feedback,” she says. “It seems like the field has accepted them well.”
Standard of Care Guidelines
Comprised of seven main measures that the commission released in October 2008, HBIPS is the result of a determined effort by the nation’s psychiatry leaders, says Noel Mazade, PhD, executive director of the National Association of State Mental Health Program Directors’ Research Institute Inc. HBIPS is available to hospitals accredited under the Comprehensive Accreditation Manual for Hospitals (CAMH), says Celeste Milton, associate project director at the commission’s Department of Quality Measurement. Free-standing psychiatric hospitals and acute-care hospitals with psychiatric units can use the HBIPS measure set to help meet performance requirements under the commission’s ORYX initiative (www. jointcommission.org/AccreditationPrograms/Hospitals/ORYX/).
The Joint Commission’s final HBIPS measure set, which went into effect with Oct. 1, 2008, discharges, followed more than three years’ of field review, public comment, and pilot testing by 196 hospitals across the country. HBIPS’ seven measures address:
—Tim Lineberry, MD, medical director, Mayo Clinic Psychiatric Hospital, Rochester, Minn.
- Admission screening;
- Hours of physical restraint;
- Hours of seclusion;
- Patients discharged on multiple antipsychotic medications;
- Patients discharged on multiple antipsychotic medications with appropriate justification;
- Post-discharge plan creation; and
- Post-discharge plans transmitted to the next level of care provider.
“These are all areas that are of interest to NAMI,” Dr. Duckworth says. “We still have a long way to go, but it’s definitely a step in the right direction.”
The measure set’s effect on psychiatric hospitalists will depend on physicians’ responsibilities at the facilities where they work, Milton says. For example, a psychiatric hospitalist may be asked to screen a patient at admission for violence risk, substance abuse, psychological trauma history, and strengths, such as personal motivation and family involvement (HBIPS Measure 1). Another qualified psychiatric practitioner, such as a psychiatrist, registered nurse, physician’s assistant, or social worker, could perform the screening, she says.