Case Study

Abstract

A design change that reduced the openness of the unit resulted in the reduction of seclusion and restraint.

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

“…Twenty-six of the 46 articles reported on strategies that encompassed all mental illness presentations to the ED ( Table 4 ). The 11 types of strategies implemented in ED included decision support tools [e.g., modifications to electronic medical record (EMR)] ( 62 , 63 , 67 , 79 ), discharge and transfer of care (e.g., collaboration and communication processes) ( 62 , 63 , 81 ), liaison psychiatry services (e.g., included ED staff in meetings) ( 63 ), telepsychiatry (e.g., assessment) ( 64 , 82 ), changes to roles and rostering (e.g., mental health professions in ED) ( 63 , 65 , 69 , 73 , 78 , 80 , 83 ), specialised units within ED (e.g., behavioural assessment unit) ( 66 , 72 , 75 , 76 , 85 , 86 ), education and training (e.g., related to mental illness) ( 68 ), intervention teams (e.g., multidisciplinary team) ( 70 , 84 ), standardising protocols (e.g., procedures for agitated behaviour management) ( 71 , 78 , 79 , 86 , 87 ), environmental design (e.g., glass doors) ( 74 ), and case management (e.g., facilitating connections with services) ( 77 , 86 ). System performance effects (e.g., ED LoS and use of restraint) were reported for all 11 strategies, 7 strategies reported patient outcomes (e.g., ED utilisation), 6 strategies reported patient experience (e.g., preferences), and 8 strategies reported staff experience (e.g., confidence).…”

“…System performance effects (e.g., ED LoS and use of restraint) were reported for all 11 strategies, 7 strategies reported patient outcomes (e.g., ED utilisation), 6 strategies reported patient experience (e.g., preferences), and 8 strategies reported staff experience (e.g., confidence). Fourteen of the 26 articles included an academic medical centre ( 63 , 65 , 66 , 68 , 70 , 74 , 76 , 77 , 79 , 83 – 87 ), and 3 of the 26 included a community hospital ( 62 , 69 , 73 ). Nine of the 26 studies did not report the type of participating hospital ( 64 , 67 , 71 , 72 , 75 , 78 , 80 – 82 ).…”

“…Eighteen of the 26 articles were conducted in urban settings ( 63 , 65 , 66 , 68 – 70 , 72 , 75 – 77 , 79 – 81 , 83 – 87 ), with one reporting an additional rural site ( 84 ), and two reported only rural sites ( 73 , 82 ). Five of the 26 studies did not report the setting as either urban or rural ( 62 , 64 , 67 , 71 , 74 , 78 ). Thirteen articles reported that the participating EDs were connected with psychiatric crisis services ( 62 , 69 – 71 , 74 – 76 , 78 , 79 , 82 , 85 – 87 ), and 13 did not ( 20 , 63 – 68 , 72 , 73 , 77 , 80 , 81 , 83 ).…”

“…Five of the 26 studies did not report the setting as either urban or rural ( 62 , 64 , 67 , 71 , 74 , 78 ). Thirteen articles reported that the participating EDs were connected with psychiatric crisis services ( 62 , 69 – 71 , 74 – 76 , 78 , 79 , 82 , 85 – 87 ), and 13 did not ( 20 , 63 – 68 , 72 , 73 , 77 , 80 , 81 , 83 ).…”

Environmental Transformations Enhancing Dignity in an Acute Psychiatric Ward: Outcome of a User-Driven Service Design Project

“…Most studies on how physical environment may influence patients are from general or forensic wards ( Borckardt et al, 2011 ; Curtis et al, 2013 ; Karlin & Zeiss, 2006 ; Lundin & Caira, 2018 ; McCurdy et al, 2015 ; Papoulias et al, 2014 ; Sheehan et al, 2013 ; van der Schaaf et al, 2013 ). Many of these studies find that the same design elements as our study of feeling of privacy, separate bathroom, and a view of nature have a positive influence.…”