Impact of an Innovative Psychiatric Consultation Liaison Model on Provider Satisfaction with Care of Behaviorally Complex Patients.

OBJECTIVES: The increasing behavioral acuity and complexity of hospitalized patients overwhelms providers' capacity to effectively manage their behaviors. Hospitals must train their providers in how to cope with these behaviors to provide high-quality care. In addition to improved patient care, increased capacity to manage these challenging patients may improve resilience and reduce the risk and rates of provider burnout. We created a novel service to address this need via point-of-care resources. This service dually helped providers manage disruptive behaviors while training them to manage these behaviors more autonomously in the future. We tracked the impact of this service on physician and staff satisfaction. METHODS: We sent pre- and postimplementation surveys consisting of five-point Likert and free-response questions to a convenience sample of providers to assess their attitudes and perceived comfort level, as well as their subjective strengths and weaknesses when managing complex behaviors. RESULTS: Pre- and postintervention analyses of qualitative data revealed that staff members were more satisfied with the available resources for managing disruptive patients following implementation of this service than before its implementation. The majority of respondents believed previously unmet needs were frequently addressed through service involvement and consultation. CONCLUSIONS: In University Hospital at Michigan Medicine, this novel service improved physicians' and staff's perceptions of available education and supportive resources for patients' behaviors, as well as their comfort in psychiatric and behavioral symptom management, including nonpharmacologic and pharmacologic interventions.

National Survey on Pediatric Acute Agitation and Behavioral Escalation in Academic Inpatient Pediatric Care Settings.

BACKGROUND: Pediatric acute agitation and behavioral escalation (PAABE) is common and disruptive to pediatric inpatient health care. There is a paucity of literature on PAABE in noncritical care inpatient pediatric care settings with little consensus on its evaluation and management. METHODS: In January 2016, a 34-question survey was e-mailed to pediatric hospitalists and consultation-liaison psychiatrists through their respective professional listservs. Excluded responses included incomplete surveys, and surveys from providers in community care settings. The survey consisted of multiple-choice questions, rating scales, and free-text responses relating to the identification, education, and evaluation and management of PAABE at the respondent's respective hospital. RESULTS: Responses were obtained from 38 North American academic children's hospitals. Of the respondents, 69.3% were pediatric hospitalists and 30.7% were pediatric psychiatry consultants. Most respondents practice in urban areas (84.2%), and in hospitals with ≥100 beds (89.4%). Overall, 84.2% of the respondents encountered PAABE at least once a month and as frequently as every week. Most respondents (70.0%) rated PAABE as an 8 or higher on a 10-point Likert scale. Despite being highly important and common, 53.9% of respondents do not screen for risk factors for PAABE, 63.6% reported no formal process to facilitate caregiver involvement in managing PAABE, and 59.7% indicated no physician training in PAABE evaluation and management. CONCLUSION: Many pediatric hospitals identify PAABE as a great concern, yet there is little training, screening, or standardization of care in PAABE. There is a need to consolidate existing knowledge regarding PAABE, while developing enhanced collaboration, training, and standardized practice in inpatient PAABE.