Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., said it has implemented a systemwide behavioral health model that reduced behavioral health boarding admissions by 78% and shortened patients’ length of stay by more than 50%.
The hospital credited the reductions to a recently hired behavioral analyst who provided real-time guidance while reducing restraint utilization by 67%, according to a Feb. 25 article by the Children’s Hospital Association. The improvements followed the rollout of multidisciplinary workflows, communication practices and tools embedded across the inpatient unit and the emergency department.
“What was happening before was the right hand never knew what the left was doing,” Heather Kreth, PsyD, director of acute behavioral health, said. “It’s been a long journey, but we’ve taken a multidisciplinary approach to make sure we are doing as much as possible to provide individualized care for patients and improve safety.”
Leaders and front-line staff integrated twice-daily behavioral acuity huddles into daily operations. The 10-minute check-in reviews patients with elevated behavioral needs to improve situational awareness and support proactive planning. A weekly multidisciplinary workplace violence event huddle reviews patient safety events, spending 5 to 8 minutes on each incident to identify patterns and assign actions items.
The hospital also launched a behavioral emergency support team to provide immediate assistance focused on patient behavioral de-escalation. The pilot relied on existing staff rather than adding new full-time positions.
The initiative comprises five standardized tools: the Broset Violence Checklist, completed within four hours of admission for certain patients under 18; individualized admission order sets based on risk factors such as suicide risk or aggression; a My Health Passport document capturing patient preferences and triggers; a stoplight safe-activity list to guide coping resource access; and a shared behavioral plan of care embedded in the EMR for high-acuity patients.
A behavioral health task force composed of clinical and quality improvement leaders, a project manager and executive sponsors oversees the initiative and meets regularly to support ongoing progress.
