The flowchart for psychiatric admission assignment
The flowchart for psychiatric admission assignment
The purpose of this paper is to identify, discuss, and evaluate the workflow process my organization has adopted for the admission of new patients from the inception of their arrival to the hospital, with a transition of being admitted to the inpatient unit or getting discharge, and the various steps involved in this process, by utilizing a designed flowchart for the transitional care of patients from the intake departments to the units. Workflow in nursing informatics could be defined as a progression of tasks, events, and interactions that are designed to add value to the work process of an organization’s activities (McGonigle and Mastrian, 2015). While workflow is termed as stated, it also involves the execution of a series of tasks in a predetermined sequence (McGonigle and Mastrian, 2015). With an understanding of this definition, this paper will further discuss the different roles health care workers play in my organization workflow process, and the metrics utilized to measure the effectiveness of the workflow, and then identify possible areas of waste.
The organization I am currently employed with is an 84-bed inpatient mental and behavioral health facility, dedicated to serving the specialized needs of children, adolescents, adults, and seniors with mental health issues such as depression, anxiety and stress, bipolar disorder, behavioral problems, and alcohol abuse dependency. This organization accepts patients that are voluntary walk-ins, transfers from other facilities like medical hospitals, group homes, nursing homes, and from other behavioral health hospitals (per patients request or due to insurance reasons). Also, patients that present with police officers under a detention warrant (DW) are also included in this category of candidates for admission, except on rare occasions where an officer may present with a patient on a voluntary status, after the officer assumes that this patient just needs help with a police escort to a behavioral facility, and the patients presenting behavioral or complain is not justifiable to be under a warrant.
Upon patients arrival to the hospital’s front desk lobby by any of these means listed above, the receptionist at the front desk lobby is always present to receive and welcome them into the facility. This receptionist immediately registers this patient’s arrival information on the electronic computer screen for a free assessment as part of the Emergency Medical Treatment and Labor Act (EMTALA), which is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay for treatment. A Mental Health Technician (MHT) and a Licensed Master Social Worker (LMSW) are called upon via phone by the receptionist with information about the arrival of this new patient. The MHT and LMSW then walk up to the front desk lobby to escort this patient to an assessment room in the intake department for an interview, and also to promote privacy as part of the Health Insurance Portability and Accountability Act (HIPAA), which is a legislative law that provides data privacy and security provisions for safeguarding patient’s medical information. In this chamber, a handheld security detector is used to wand this patient and also physically searched for contrabands as part of the hospital policy and procedure, and also the Joint Commission standard of practice in ensuring the safety of this patient and every other one around in the facility. The MHT then enters the assessment room to check the patient’s vital signs with an electronic blood pressure monitor. The LMSW at this time starts to complete an integrated psychosocial assessment on this patient. Upon completion, the patients information is inputted in the Electronic Health Record (EHR) computer system called ‘ReadyAnswer’ in a SBAR (S-Situation, B-Background, A-Assessment and R-Recommendation) format, and then forwarded to the Telemedicine admitting physician via the computer to view all the necessary information needed to be known about this patient before any video encounter begins between this physician and the patient.
This phase of a video encounter and assessment of the patient by the physician, also known as Telemedicine is a major step along this transition because it determines if the patient would be getting admitted to the facility, getting discharged, or referred to the outpatient day clinic. Based on this patient’s presenting and past history, the LMSW recommendation, and the physician’s assessment of the patient with his or her qualified experience, a final recommendation is made about this patient presenting status. Once the physician completes his interview and makes his or her recommendation, he puts the orders in the Computerized Provider Order Entry (CPOE) in the patients EHR, which almost always includes the patients admitting diagnoses, some form of laboratory work, specific precautions and observations, medications, with a host of other orders for the nurses to carry out. If a patient is recommended for discharge or outpatient care, but initially presented under DW with a police officer, the DW is lifted-off by the physician and a cab is called upon and requested to drop off patient back to their place of residence to ensure they are adequately and safely discharged to their place of residence as part of the hospital discharge safety plan for patients, otherwise if a patient is recommended for an inpatient admission, then the patient would be transferred to the unit for a continuous care and monitoring by the nurses and the attending physicians on the units.
Leaders of healthcare organizations often design workflow with efficiency and effectiveness in mind (Laureate Education, 2012f). With a well-designed system in my organization to ensure an efficient and effective admission transition, Time and cost, are tools currently used to measure the soundness of the workflow and the quality of care we provide to our patients from the moment they walk into our facility. As part of our hospital policy to ensure a timely transition in the admission process, a maximum of a one-hour window time frame as been implemented for this admission process, which is being daily evaluated and audited by the intake manager based on the information entered in our electronic EMTALA log by the receptionist in an entirely different department as previously stated. In evaluating cost as a tool for the measurement for effective workflow and quality care, there is a defined amount of employee scheduled to work in this department daily and around the clock. These employees range from the physician to the LMSW and MHT, who are scheduled based on the organizations budget to meet up with the influx of patients seeking a psychiatric evaluation.
In my opinion, a missing piece to this line of admission process where improvements could occur to bring about a change in the workflow is the involvement of nurses in this admission process. Nurses possess much-advanced skills that could help with a better coordination of this transition. With the presence of a nurse, a patient can be assessed upon arrival for any medical concerns that immediately needs to be addressed and referred out for medical clearance in the medical emergency department. Also, if the Telemedicine physician considers a patient suitable for discharge or recommends an outpatient treatment, but the nurse physically present with this patient has a doubt about this decision based on his or her own assessment, this patient can then be advocated for by this nurse by presenting his or her concerns about the circumstances surrounding his or her opinion about this suggestion. Lastly, the ability to critically think, and the application of evidence-based knowledge to make sound decisions in a situation where a Telemedicine physician is temporary unreachable due to a situation like technical difficulties experienced in the phase of admission makes the presence of a nurse in this line of admission critical.
In ensuring the delivery of a safe and quality care to patients by healthcare professionals, it is important for nurse managers to be aware of the flow of activities and implement changes or adjustments as necessary for an adequate workflow patterns that maximize the effective use of resources and minimize activities that brings about waste of resources. In a situation experienced by my organization, in reckoning that importance of a nurse in this admission process could bring about quality improvement.
