Changing a Staffing Model for Low and Moderate Risk Patients in an Emergency Department: A Quality Improvement Project

Abstract

The goal of this quality improvement project was to change the staffing model for low and moderate risk suicidal patients in an emergency department, from one- on -one observation to camera observation, RN and Mental Health Technician to interact with the patients. The patients would not be limited to a stretcher or one space but would be free to move about a designated area. The patients who could reside in this area, would be screened by both the Columbia (C- SSRS) and the Safe T. This intervention was intended to determine if this new staffing model with camera observation would be effective, safe for both patients and staff, and provide not only staff satisfaction, but some financial savings as well. Analysis of the data revealed that there were no adverse events with this new staffing model after eight weeks of implementation. After surveying the nurses, it was determined that this new model was preferred over the one-to-one observation model, where patients remained in the main ED in the hallway. During the time period of the intervention, there were no incidents of violence or suicide attempts while utilizing camera observation as compared with traditional staffing of one- on- one observation. In addition, it was determined that there was a savings of $91,015.68 mentioning this value/amount as compared with the traditional one on one observation model during the 8-week trial period. The screening tools of Columbia (C-SSRS) and the risk assessment tool, Safe – T were used 100% of the time in order to determine appropriate inclusion in this project. Therefore, this new staffing model is an appropriate improvement for both nurses and patients as compared to a one- on- one sitter with patients residing in the hallways of the emergency department.