Implementing Psychiatric Safety Planning in the Adult Emergency Setting to Decrease Re-Presentation

Abstract

Problem & Purpose: In the previous year, of those who complete suicide, 31.1% were seen in the emergency department (Schaffer et al., 2016). This statistic presents an important opportunity for intervention within healthcare. The purpose of this quality improvement project was to improve discharge planning by implementing the Stanley Brown Safety Plan (SBSP) in the Psychiatric Emergency Service (PES) for patients who report suicidality before discharged. Methods: This project implemented the SBSP within the adult PES of a large urban academic hospital. The process change was to measure the number of patients who have documentation related to the SBSP in their chart upon chart audit. The data collection process utilized a “student- developed” chart audit model based on an electronic medical record report that is composed of date, CSN of patient, staff member, and whether the SBSP or refusal of participation was documented. The structure measures were education of the staff and feedback provided to the staff based on weekly audits. Results: Education of staff pre-implementation and individualized feedback provided had 100% compliance throughout the project. Patients who had documentation of SBSP or refusal to participate in their project in their chart was successful; demonstrated by weekly improvement throughout the project and project high of 82% in the last week. The compliance ranged from 29% to 82% with a median of 41.5, a mean of 53.8 and a standard deviation of 15.8. Re-presentation rates increased from 18% in the first month data was recorded to 34% in the last month of recorded data with a median of 29.6, a mean of 28.6 and a standard deviation of 4.7. Conclusion: Clinical staff’s knowledge on safety planning improved after education training. The documentation score suggests that the standardized safety planning protocol was easy to use and implement as the standard of care. Findings highlighted the confounding variables that effected the safety planning protocol’s ability to prevent re-presentation. Standardizing the safety planning protocol and educating the clinical staff on safety planning not only improved the documentation but is essential to improving discharge planning for the suicidal patient.