Mental Health Boarding on Inpatient Units
Dr. Krause
Presenter: Heather Kreth, PsyD, Vanderbilt University Medical Center and Monroe Carrel, Jr. Children’s Hospital at Vanderbilt, Nashville, Tenn.
Dr. Heather Kreth, a child and adolescent psychologist, began her behavioral-health-themed session by stating: “I am an honorary hospitalist.” She practices in a unique setting by being employed within the division of pediatric hospital medicine at Vanderbilt University Medical Center and Monroe Carrel, Jr. Children’s Hospital at Vanderbilt, in Nashville, Tenn. Dr. Kreth described how pediatric hospitalist divisions can, “do the best we can despite limited resources” in the care of our growing child and adolescent mental-health-related hospital admissions.
The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in children’s mental health in the fall of 2021. Dr. Kreth cited studies that show mental health boarders make up 26-49% of any given pediatric hospital census. The average length of stay for these patients is two to three days in the inpatient medical unit.
The session described the innovative staffing model of her program. Dr. Kreth functions as the primary psychologist working in tandem with a pediatric acute care nurse practitioner to staff mental health patients in need of medical stabilization at their hospital. This behavioral health team has been in place since 2018 and has shown clear benefits by decreasing staff harm events related to agitated patients by 90%. Violent-restraint usage has dropped by 30%. Dr. Kreth attributes these improvements to intensive staff education that she provides on topics such as verbal de-escalation techniques, suicide safety, and tactics for mental health technicians (instead of patient sitters) at the bedside. Her behavioral health team has shown a significant cost-savings effect on hospital administration. Their average length of stay decreased from 2.79 days down to 1.81 days.
Key Takeaways
- There’s a clear benefit to having behavioral health become a part of the hospitalist service rather than a separate consultation service.
- A highly functioning behavioral health team with multi-disciplinary services will provide clear benefits with decreased staff harm and decreased length of stay for behavioral health patients.
- A huge part of the solution is access to mental health services in the community as well as decreased associated stigma.
Dr. Krause is a pediatric hospitalist and associate professor of pediatrics at the University of Louisville affiliated with Norton Children’s Medical Group, Louisville, Ky.