Providing a safe, quiet designated area in the EDs of hospitals is essential for the proper care of a patient with psychotic behavior who requires extraordinary consideration during treatment.
The idea and method for utilizing such appropriated space is not exactly new for hospitals. But the classification, design, and way such space is used today by hospitals and ED nurses is entirely new.
There was a time when such areas like these were called seclusion rooms, but today, they are called holding rooms and viewed very differently for their purpose, says Cheryl Craig, RN, MA, clinical director for mental health services at CentraState Medical Center in Freehold, N.J. This is not about seclusion. This is treatment in a safe and private room space, but not about restricting a patient. We are very cognitive about todays social stigmas.
Craig, who has been working in the ED at CentraState Medical Center for two years, is proud of the vision shared by the medical center about the wellness and priorities for caring for patients who come to the hospital for emergency care.
Though the Emergency Nurse Association designated psychiatric emergency patient care this year as one of the practice priorities highlighted in the national organizations 2009 ENA Strategic Plan, Craig said CentraState realized the same need five years earlier.
In November 2004, CentraState celebrated the grand opening of a $10 million ED that included an expansion that nearly doubled the size of the ED from 17,500 to 32,000 square feet, adding 21 treatment rooms for a total of 48, with 44 of them as private rooms.
But one of the specialized features of the expansion hailed in the community, was the addition of a separate three-room mental health assessment and treatment area.
Whats most important is the safety of all patients, says Lori Impastato, RN, assistant nurse manager for the CentraState ED, who has been with the medical center for 20 years. If a patient is showing signs of mental instability or has an explosive outburst, this allows us to take that person to a calm area with constant one-on-one monitoring as the assessment process begins.Ann Cole, RN
Far from the images of the seclusion rooms of early hospital days, CentraStates holding rooms are private examination rooms, which include individual TVs (mounted behind plexiglass) that create a diversion for patients to feel comfortable and more relaxed as they receive care. The rooms are separated from the rest of the ED by a set of doors that include an alarm system to provide even further monitoring.
The location of this area is very key because privacy is very important to the process and for preventing further anxiety to the patient while also preserving dignity, Craig emphasizes.
She says more people visit the ED every year for both traditional emergency care and primary care, making it a very high traffic area with the number of patients treated in the ED increasing each year by 2,000 to 3,000 people.
Craig says the higher numbers today include many more mental health patients because of better community education and awareness about more services and treatment available for patients with psychiatric concerns.
Laurie Gambardella, RN, BSN, clinical director for emergency services of the CentraState ED, has been with the medical center for nearly four years and witnessed a significant improvement in the quick response the ED staff provides for getting patients with psychiatric concerns care and treatment with less wait time.
The holding rooms in our ED are used each day, and just since February 2008, the nursing staff has been able to decrease the time these patients stay in the ED area by nearly half, from 11 hours to just six hours, just by better assistance and communication during the entire process, Gambardella says.
She said a task force consisting of members from the ED, including many nurses, was assembled last year to evaluate the entire system used for the care and processing of all patients who enter the ED.
A triage board computer program and screen display system, now used to track every patients status and time spent during his or her ED stay, is one of the ways that has helped improve both the experience for patients and staff, while expediting the entire process.
Speed, without sacrificing care and quality of service, has been very important, especially for patients requiring psychiatric care, Gambardella says. We want to get them the assessment and treatment they need without too much wait. And were able to do that now with these rooms and the system we have in place.
At Trinitas Regional Medical Center in Elizabeth, N.J., not only does the facility have holding rooms, it also has its own separate ED for psychiatric emergency services, including an observation unit for mental health patients.
Ann Cole, RN, a psychiatric nurse for 15 years, including four years in the psychiatric ED at Trinitas, said the special ED for mental health patients was created in 2000 when the Trinitas three hospital system began. Because three mental health-specialized hospitals closed, Trinitas began to see more patients who needed psychiatric services.
Weve found having a separate ED for psychiatric needs is much easier for both the staff and for patients needs, Cole says. What was once a five-hour wait time for assessment and paperwork, can be reduced to an hour-and-a-half process to get these patients the help they need in a private and comfortable setting.
Tony Trachta, a licensed social worker who is program director of psychiatric emergency services at Trinitas, says as many as 30 patients are seen a day in the hospitals psychiatric ED, resulting in a total of as many as 800 patients served a month.
Cole and Trachta say because the area served by Trinitas includes a high need for psychiatric nursing services, Trinitas also has spent the past decade providing mobile screening as needed, with psychiatric nurses sent to private residences as well as nursing homes to address mental health concerns even before a patient reaches the point to require the attention provided at a moments notice by coming to the Trinitas psychiatric ED.
Its all about helping others get the best care in the best surroundings possible, Cole says. And because of the related considerations that come with treating and assessing a patient with mental health concerns, it adds an additional responsibility for the nursing staff of any ED, and the need for a special environment to offer immediate and focused attention to every patients special situation.