October 31, 2012 Newsletter

We’d like to bring to your atttention the following article:

Simple tool may help evaluate risk for violence among patients with mental illness

Recently reported by National Institute for Mental health


Mental health professionals and others who often have to evaluate and manage the risk of violence by patients may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco. Alan Teo, M.D led the study of the use of an instrument to assess the risk of violence.

The study showed that when researchers applied the information from the “Historical, Clinical, Risk Management 20 -Clinical” (HRC-20-C) scale – a brief, structured risk assessment tool – to patients, accuracy in identifying their potential for violence by residents increased to a level nearly as high as the faculty psychiatrists’, who had an average of 15 years more experience. Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients.

The study was published Aug. 31 in the journal Psychiatric Services. The HCR-20-C was developed several years ago by researchers in Canada, where it is used in a number of settings such as prisons and hospitals. However, in the United States, structured tools such as the HCR-20-C are only beginning to be used in hospitals. It shows that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence.

The study included 151 patients who became violent and 150 patients who did not become violent. The patients in the study had severe mental illnesses, often schizophrenia, and had been involuntarily admitted to the hospital.

Register now for the Dec 5 seminar described below.

Click here for information and to register 

IBHI is offering a full day seminar on Improving Emergency Department Care for People with Behavioral Health Problems to be held on Dec 5th in Las Vegas.  
The Joint Commission has issued two changes in accreditation requirements for hospitals which are designed to improve emergency care and address “boarding.” These changes also have the potential to affect community based providers other than hospitals. The new requirements are revisions to Standard LD.04.03.11 and Standard PC.01.01.01; and are identified as Revisions to Address Patient Flow Through the Emergency Department. 

These changes will affect both hospitals and community providers.

The new Commission requirements expect hospitals and related accredited organizations to “Set Goals” for the components of the patient flow process, and it identifies examples of the areas to be considered. The standards are especially designed to encourage hospitals to develop plans for limiting “boarding.”   This has been a frequent topic in our Emergency Care Improvement Collaborative and Seminars. The second standard reinforces the need for focusing on people who remain in Emergency care while awaiting a placement within the context of the care available. These are people often thought of as “boarded.” 
Specifically, revisions to Standard LD.04.03.11 address the following concerns for all patients, including those with behavioral health emergencies:

·  Leadership use of data and measures to identify, mitigate, and manage issues affecting patient flow throughout the hospital

·  The management of ED throughput as a system-wide issue

·  Safety for boarded patients (the practice of holding patients in the ED or another temporary location after the decision to admit or transfer has been made)

·  Leadership collaboration with behavioral health providers and authorities

 For patients who have been boarded because of behavioral health emergencies, revisions to Standard PC.01.01.01 address safety in the following areas:

·.Environment of care

· Staffing

·Assessment, reassessment, and the care provided

These changes seem destined to require modification of ED operations, and open a new era of connection between hospitals and community providers, which will demand greater understanding, coordination and joint quality improvement. 

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