Schizophrenia and potentially preventable hospitalizations- instED
Many circumstances may prevent a schizophrenic patient from living a great life. Patients with chronic mental illnesses such as schizophrenic patients are often limited in their ability to live independently. They are challenged with and continue to experience sudden manic episodes, delusions, hallucinations, and poor thought processes. When they are struggling, they need support, reassurance, and guidance; the goal of healthcare professionals is to reduce the number of unnecessary ED visits. During 2009–2011, an estimated 382,000 emergency department (ED) visits related to schizophrenia occurred each year among adults aged 18–64, with an overall ED visit rate of 20.1 per 10,000 adults. Psychiatric patients who are living independently may experience sudden manic episodes, delusions, hallucinations, and poor thought processes.
Schizophrenic patients continue to face barriers to receiving care due to poor symptoms management, communication difficulties, cognitive impairment, lack of social support, and a lack of willing or available caregivers. Many issues have evolved in terms of the impact of hospitalization on schizophrenic patients, poor coping skills, and cognitive and functional capacity of patients with schizophrenia. Schizophrenia continues to be associated with high hospitalization comparing to other complex medical needs such as diabetes mellitus long-term complications and diabetes-related lower extremity amputation, conditions characterized by long-term deterioration. Schizophrenic patients have been going back to ED within 30 days or less for many reasons. The frequent unnecessary ED visit is mostly related to poor medication management, unplanned-quick discharge, mental health stigma, and lack of advocacy for patients and family (McCaig LF 2015).
Recurrent ED users who present with acute symptoms of mental illness continue to show a significantly higher number of hospital admissions to psychiatric clinics compared to patients with complex medical needs.
For patients with psychotic disorders on medical–surgical units, data and analysis indicate that these patients want to be more active participants in their health care but feel helpless due to chronic symptoms of mental illnesses. Providers and policy factors made it harder to endure the intense physical and emotional burden they experience during hospitalization, though positive interactions with certain providers were important and provided comfort during this difficult time. They receive discrimination and also misunderstanding during a crisis.
Hospitals are working hard to reduce their thirty-day readmission, they focus on post-acute care partners to ensure that the mental health symptoms of their recently discharged patients are being assessed and addressed. Many hospitals should work with their local public health entities, to ensure that preventative and non-preventative mental health services are available to all members of the community and especially for patients recently discharged from acute care settings or long-term inpatient facilities with a recent diagnosis of schizophrenia.
Problem Statement
Unnecessary ED visits pose a major risk to patient care so the question is, will mobile emergency services decrease the rate of unnecessary emergency visits and readmissions in schizophrenic patients over the course of 6 months?
PICO:
P= people/population: patients with schizophrenia
I= Intervention: Paramedics staffs responsible to deliver urgent medical care services at home for patients with chronic mental illnesses (schizophrenic), who are at high risk for hospitalization; who need help with treatment adherence.
C= Comparison group: The availability for the service is 24-hour mobile crisis and 24-hour hotline. Poor adherence to treatment, which is a strong predictor of relapse in schizophrenia is the reason why they frequently go to ED.
0= Outcome: The utilization of mobile paramedics ED can divert the unnecessary time wasted at the ED and get them appropriate care in their homes. Will or will not increase the rate of compliance with treatment plans for patients with schizophrenia? Mobile ED provides high-quality and compassionate care that reduces avoidable emergency department visits and fills the gap between primary care and emergency care even for patients with the most complex care needs such as schizophrenic (Rosen et al., 2014)
T= Time: over the course of 6 months.
An emergency department (ED) visit presents a unique opportunity to establish a positive relationship based on a patient’s opinion of the quality and value of the care received. However, in attempting to achieve excellence in patient experience, ED leaders are challenged by factors intrinsic to the ED care environment, including overcrowding, long waits, communication challenges, uncomfortable physical environments, and often unsatisfactory pain control and privacy.
Methods for Improvement
An improvement will be noted when there is a reduction of ED visits over the course of the three months following training on utilization of instED.
Treatment data will be noted, compiled, and compared for the duration of the time. Nurses will also receive an interactive session with highly trained instED paramedics staff responsible for delivering urgent medical care services for patients with chronic mental illnesses who are at high risk for hospitalization and who need help with treatment adherence. Nurses will explain more about their role as well as provide support and guidance
Interventions
Nurses will maintain mandatory trainings that will address the new services. The instED team will also come to nurses’ meetings to discuss the evaluation process of the patients on how to use instED.
InstED staff will stay connected with patients’ providers such as their primary care provider and psychiatric prescriber after each visit.
The 24 hours instED phone number will be available to all patients, nurses, and caregivers. Patients will be encouraged to understand the service by asking questions and, requesting any information to decrease anxiety and frustration.
Nurses will encourage patients/caregivers by letting them know that with instED, they will have peace of mind knowing they are cared for by highly trained paramedics in the comfort of their own home, and they will be kept informed of the care they receive.
Results
The goal of this research is to reduce unnecessary Emergency Department visits among schizophrenic patients by 25% in 3 months and 50% in 6 months. Daily data was collected into a monthly record chart (see Appendix A) and these data will be plotted on a bar chart (see appendix B) for the six (6) months preceding the quality improvement project. Appendix C shows the number of unnecessary ED visits over a period of 6 months after the project was implemented.
The research intervention will help establishing areas in the Plan-Do-Act-Study cycle. These areas will help determine cycles that needs improvement and create appropriate changes. These data will be analyzed weekly and then reviewed monthly.
Analysis
These charts will help the team understand the effort to decrease unnecessary ED visits.
The collected data can be shared with others for analysis and evaluation. These charts will be used as an evaluation tool showing the research outcomes. It is important for the teams involved to evaluate whether the project has been successful or not.
Research recommendation method, these charts will present in clear details an anticipated reduction of ED visits.
InstED staffs will present the following interventions methods on how to educate patients and families on utilization of available instED numbers.
Nurses will reinforce teaching and assist patients and, families on how to call instED phone numbers. Nurses will re-educate patients on the screening process to relieve stress and anxiety. The main goal of this research is to improve patient care, promote health safety, and decrease ED visit.
Charts
Conclusion
The overcrowding of Emergency department (ED) visits presented a public health concerns associated with high healthcare costs, longer ED screening time, longer waiting time, patient frustration, patient satisfaction, and higher mortality rate. There is a significant financial impact on the healthcare system related to frequent ED visits. The author explained that the goal to reduce frequent ED visits has significantly decreased the cost and saved 10 million dollars in charge in the US healthcare system. In the last decade, the number of ED visits has significantly increased and posed a lot of questions and concerns about the quality of care delivery system.
Patients with chronic mental disorders are most likely to be frequent emergency department (ED) users than patients with complex medical needs. This article is a quantitative research of recurrent Emergency visits of patients with mental disorders. These patients with chronic mental illnesses frequently go to the ED for a long list of diagnoses including Personality disorder, Bipolar disorder, Post-traumatic stress disorder, Generalized anxiety, Obsessive-compulsive disorder (OCD), Attention deficit hyperactivity disorder, Anorexia nervosa, Bulimia, Substance abuse disorder, Alcoholism, Borderline, and Major depression disorder. It is imperative that schizophrenic patients get the care that they deserve, reducing the rate of readmissions is really important to the healthcare system.
References
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Sorhaya Zamor RN, BSN 2-12-24
Assessed and Endorsed by the MedReport Medical Review Board
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