Skip to main content
SpringerLink
Log in

The Impact of Designated Behavioral Health Services on Resource Utilization and Quality of Care in Patients Requiring Constant Observation in a General Hospital Setting: A Quality Improvement Project

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

Constant observation (CO) is a common economic burden on general hospitals. A quality improvement (QI) project focusing on behavioral health (BH) management of this population was piloted using a novel BH protocol for the proactive assessment and management of all patients requiring CO. The impact on CO-cost and length of stay (LOS) was assessed. Data on demographics, diagnoses, psychopharmacologic treatment, complications and clinical setting were collected and analyzed for all CO-patients over a 6-month period. Cost and LOS data were compared with a similar sequential group prior to project implementation. Out of the 533 patients requiring CO during the study period, 491 underwent the protocol. This QI-project resulted in a significant reduction in the average monthly CO-cost by 33.06% and a 15% reduction in LOS without any increase in complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Adams, J., & Kaplow, R. (2013). A sitter-reduction program in an acute health care system. Nursing Economics, 31(2), 83.

    PubMed  Google Scholar 

  • Cruze, C. (2015). Healthcare integration in the era of the Affordable Care Act. Retrieved May 11, 2017, from http://abhw.org/publications/pdf/IntegrationPaper.pdf.

  • Desan, P. H., Zimbrean, P. C., Weinstein, A. J., Bozzo, J. E., & Sledge, W. H. (2011). Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics, 52(6), 513–520.

    Article  PubMed  Google Scholar 

  • Harding, A. D. (2010). Observation assistants: Sitter effectiveness and industry measures. Nursing Economics, 28(5), 330.

    PubMed  Google Scholar 

  • Inouye, S. K. (2006). Delirium in older persons. New England Journal of Medicine, 354(11), 1157–1165.

    Article  CAS  PubMed  Google Scholar 

  • Kathol, R., Sargent, S., Melek, S., Sacks, L., & Patel, K. K. (2015). Non-traditional mental health and substance use disorder services as a core part of health in CINs and ACOs. In K. Yale et al. (Eds.), Population health and accountable care (3rd ed.).

  • Khachiyants, N., Trinkle, D., Son, S. J., & Kim, K. Y. (2011). Sundown syndrome in persons with dementia: An update. Psychiatry Investigation, 8(4), 275–287.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kuehn, B. M. (2005). FDA warns antipsychotic drugs may be risky for elderly. JAMA, 293(20), 2462.

    Article  CAS  PubMed  Google Scholar 

  • Lamdan, R. M., Ramchandani, D., & Schindler, B. (1996). Constant observation in a medical-surgical setting: The role of consultation-liaison psychiatry. Psychosomatics, 37(4), 368–373.

    Article  CAS  PubMed  Google Scholar 

  • Laws, D., & Crawford, C. L. (2013). Alternative strategies to constant patient observation and sitters: A proactive approach. Journal of Nursing Administration, 43(10), 497–501.

    Article  PubMed  Google Scholar 

  • Ogrinc, G., Davies, L., Goodman, D., Batalden, P., Davidoff, F., & Stevens, D. (2015). Squire 2.0 (standards for quality improvement reporting excellence): Revised publication guidelines from a detailed consensus process. American Journal of Critical Care, 24(6), 466–473.

    Article  PubMed  Google Scholar 

  • PayScale, Inc. (2017). Psychiatric nurse practitioner (NP) salary. Retrieved May 11, 2017, http://www.payscale.com/research/US/Job=Psychiatric_Nurse_Practitioner_(NP)/Salary.

  • Rochefort, C. M., Ward, L., Ritchie, J. A., Girard, N., & Tamblyn, R. M. (2012). Patient and nurse staffing characteristics associated with high sitter use costs. Journal of Advanced Nursing, 68(8), 1758–1767.

    Article  PubMed  Google Scholar 

  • Siddiqi, N., Harrison, J. K., Clegg, A., Teale, E. A., Young, J., Taylor, J., & Simpkins, S. A. (2016). Interventions for preventing delirium in hospitalised non-ICU patients. The Cochrane Library.

  • Torkelson, D. J., & Dobal, M. T. (1999). Constant observation in medical-surgical settings: A multihospital study. Nursing Economics, 17(3), 149.

    CAS  PubMed  Google Scholar 

  • Voss, S., Black, S., Brandling, J., Buswell, M., Cheston, R., Cullum, S., … Benger, J. (2017). Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol. BMJ Open, 7(4), e016651.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Behavioral Health, NYU Winthrop Hospital, 222 Station Plaza North, Suite 350A, Mineola, NY, 11501, USA

      Aaron Pinkhasov, Deepan Singh, Sridivya Chavali & Lori Legrand

    2. Department of Psychiatry, School of Medicine, SUNY Stony Brook, 020 Health Sciences Center, Stony Brook, NY, 11794-8101, USA

      Aaron Pinkhasov & Deepan Singh

    3. Department of Biostatistics, NYU Winthrop Hospital, Mineola, NY, USA

      Rose Calixte

    Authors
    1. Aaron Pinkhasov
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Deepan Singh
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Sridivya Chavali
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Lori Legrand
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Rose Calixte
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Deepan Singh.

    Ethics declarations

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Research Involving Human Participants and/or Animals

    This article does not contain any studies with animals performed by any of the authors. This quality improvement (QI) project met SQUIRE 2.0 standards and was IRB exempt (Ogrinc et al. 2015).

    Informed Consent

    Informed consent was not required to be obtained from any individual participants included in the study as it med SQUIRE 2.0 guidelines for a quality improvement study (Ogrinc et al. 2015). No identifying information about participants is available in the article.

    Additional information

    Aaron Pinkhasov and Deepan Singh are the two joint first authors contributed equally to the writing of this manuscript.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Pinkhasov, A., Singh, D., Chavali, S. et al. The Impact of Designated Behavioral Health Services on Resource Utilization and Quality of Care in Patients Requiring Constant Observation in a General Hospital Setting: A Quality Improvement Project. Community Ment Health J 55, 31–37 (2019). https://doi.org/10.1007/s10597-018-0258-4

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10597-018-0258-4

    Keywords

    Search

    Navigation