The measures are intended to help unify the screening process used by psychiatric hospitalists; however, traditional hospitalists could be called on to perform a face-to-face evaluation of a patient placed in physical restraint or held in seclusion (Measures 2 and 3). As a result of the evaluation, hospitalists could be asked to write orders to discontinue or renew physical restraint or seclusion, Milton says. The feedback the Joint Commission has received shows psychiatric hospitalists are using the measures. They are most likely to be in charge of managing a patient’s medications and could play a role in documenting appropriate justification for placing a patient on more than one antipsychotic medication at discharge (Measures 4 and 5). Depending on the scope of practice, traditional hospitalists who discharge patients might be responsible for determining a final discharge diagnosis, discharge medications, and next-level-of-care recommendations (Measures 6 and 7). The provider at the next level of care could be an inpatient or outpatient clinician or entity, Milton says.
How It Works
The HBIPS data collection process is similar to other ORYX processes; however, this is the first time the Joint Commission has created a measure set for psychiatric services, says Dr. Mazade, who worked directly with the commission to develop HBIPS. Hospitals using HBIPS will submit data from patients’ medical records to their ORYX vendor. The vendor will submit performance measures to the hospital and the commission, which will provide hospitals with feedback on measure performance, Dr. Mazade says. Initially, the commission will supply acute-care and psychiatric hospitals the option of using HBIPS to meet current ORYX performance measurement requirements, although Dr. Mazade says he expects the commission will eventually mandate use of the measures.
The commission says data collection, analysis, and performance reporting is running behind schedule. Once the commission report is received, hospitals should share the message with their medical staff, Milton says. “This feedback will be useful to all staff involved in patient care to help them improve their practice,” she explains. “The purpose of an initial screening, including a trauma history, is to help the practitioner formulate an individual treatment plan based on information obtained during the initial screening.”
Tim Lineberry, MD, medical director at the Mayo Clinic Psychiatric Hospital in Rochester, Minn., says each HBIPS measure is composed of sub-elements. For example, the assessment measure includes admission screening for violence risk, substance abuse, trauma history, and patient strengths, such as motivation and family involvement. These elements create a more complete picture of the patient and might improve the initial assessment. By improving initial assessment, experts in the field hope hospital staff will be able to better identify problems, Dr. Lineberry says.
“We are all working for improvement in care,” says Dr. Lineberry, noting the Mayo Clinic was one of the pilot sites. “HBIPS is part of that effort.”
Time Is of the Essence
Many of the standards represent areas in which there is consensus among psychiatrists about the need for change, says Anand Pandya, MD, a psychiatric hospitalist and director of inpatient psychiatry at Cedars-Sinai Medical Center in Los Angeles. Many psychiatrists recognize there is a need to improve communication between inpatient psychiatric services and follow-up outpatient providers, Dr. Pandya says. However, a clear consensus has not been reached regarding the standards of tracking patients who take multiple antipsychotic medications, Dr. Pandya says.