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> an increased census of children with psychiatric complaints that requires hospitalization... I am curious if others have a similar situation
--> Our numbers are on the adult side, but we have (as many do) a similar problem with psychiatry being a very slow specialty at joining the 24-hour world and providing decent coverage outside "office hours". This leaves us with a "storage" issue of where to keep patients who require no treatment at all bar psych assessment and disposition.
Still, with us, they wait, generally, no longer than until the very next morning. Very rarely (through some mishap or mis-communication), to the morning after that. Never more than 36 hours in, say 1-2% of cases and under 16 hours in all others.
> ... what strategies have been used within and outside your facility to reduce LOS
--> Strategies are as follows:
- "Medical clearance": We insist on psych review as early as the patient can cope with it and do NOT accept the idea that patients should be fit for DISCHARGE medically before they are assessed. This means that we can often get them assessed soon after arrival, THEN finish our work on them - at that time it would be too late for the pysch service and we would have to wait until the next day
- Ownership: The patient is the HOSPITAL'S patient, NOT the ED's. The patient merely happens to be in the physical area of the ED, but that does not release anyone else from responsibilities. (It DOES, however, lend a greater weight to what the EP says as compared to anyone else - the respect of being the only one who's actually SEEN the patient)
- Honesty: In defining what it is the patient actually requires. If the patient is waiting for a bed, then this is an "inpatient" and the hospital, as a whole, must accept that a bed does NOT mean a corridor, nor any other arrangement within an ED. So, if there are a few days to be spent in a non-psych bed, this will happen in a general medical ward, not the ED, not an ICU, not a specialist surgical unit, not a corridor by some toilets, etc. This also makes sense numbers-wise... ONE additional "excess" patient makes less of a difference in nursing ratios on a large ward than he/she would in an ED... We have a very substantial "observation" ward, which also serves for clinical decisions, short-stay, transport delays and these sort of cases.
- Responsibility to standards: This works wonders (and not just for psych patients). If a patient is "left" in our own ED ward, where we want people to spend only a short time of <24hrs, then we will "force" whichever specialty now owns this patient to see them as often as the rest of the ward gets seen. In our ward, patients get seen every day and every time they need to be seen - there are no "fixed round times". It becomes near-impossible for other specialties to cope with this and it serves as an incentive for them to take the patients to their domain early...
Hope these translate to your place as well, even though they are not child-specific...
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