RESIDENT: Impact on Workflow and Patient Safety of Standardized Psychiatry Admission Orders at a Tertiary Care Emergency Department

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Presenting Author(s): Alex Dyck

Co-Author(s): Dr. Melanie Marsh-Joyal

Date and time: 24 Mar 2018 from 13:30 to 13:45

Location: Hawthorn C  Floor Map

Learning Objectives:

  1. To review evidence for standardized orders in routine hospital care
  2. To appreciate factors pertaining to psychiatrists, residents, and allied staff affecting the design and use of standardized orders, as demonstrated in this quality improvement case study

Literature Reference:

The art and science of preprinted physician orders. Duffy, B. J Healthc Qual. 2007 Nov-Dec;29(6):7-11, 32.

The impact of standardized stroke orders on adherence to best practices. Members of the California Acute Stroke Pilot Registry. Neurology 65(3), 9 August 2005, pp 360-365.

Preprinted standardized orders promote venous thromboembolism prophylaxis compared with traditional handwritten orders: an endorsement of standardized evidence-based practice. Gaylis, FD et al. American Journal of Medical Quality. 25(6):449-56, 2010 Nov-Dec.

Promoting Best Practice and Safety Through Preprinted Physician Orders. Ehringer, G & Duffy, B. In: Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 2: Culture and Redesign), Henriksen K et al (ed).  Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug.

 Abstract

INTRODUCTION

Hospital admitting services use standardized orders to improve interdisciplinary integration in care and promote accurate communication. Suggested safety benefits arise from promotion of evidence-based empiric therapies, transitions of care, legibility, reduced potential for medication error, and reduced calls to physicians for clarifications. This presentation discusses an initiative to develop standardized admission orders for psychiatric patients assessed in the emergency department at Royal Alexandra Hospital, Edmonton.

METHODS

Using the Institute for Healthcare Improvement format, we surveyed psychiatry residents on their emergency assessment workflow. With assistance of the departmental QI committee and individual physicians, a 4-month trial of a novel 2-page admission order set was undertaken. Feedback was collected systematically from psychiatrists, residents, and nursing staff.

 RESULTS

In the preliminary survey (n=34), residents estimated requiring up to 4 hours per Emergency assessment. A majority (56%) spend 50 minutes or more on patient contact and 62% spend more than 25 minutes writing documentation (including orders) by hand. Approximately half of calls were converted to in-house shifts



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