Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients

Stephen J. Harder; Henriette Mathis; Maryam Warsi; Kehinde Odedosu; Rebecca C. Hanna; Eugene S. Chu

doi:10.1016/j.jcjq.2022.10.004

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Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients

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Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients

Stephen J. Harder, Henriette Mathis, Maryam Warsi, Kehinde Odedosu, Rebecca C. Hanna and Eugene S. Chu

Joint Commission journal on quality and patient safety, Vol.49(1), pp.53-61

01/01/2023

DOI: 10.1016/j.jcjq.2022.10.004

PMID: 36456435

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Abstract

Background: Hospitalized medical patients with concurrently decompensated psychiatric and medical conditions expe-rience worse clinical outcomes. Health care providers caring for this patient population are at increased risk of workplace violence. The authors sought to understand the effects of a clinical microsystem specifically designed to care for patients too psychiatrically ill for medical units and too medically ill for psychiatry units.Methods: The research team performed a quality improvement study in which a medicine-psychiatry co-managed clinical microsystem incorporating high performance teamwork principles was engineered in an urban academic medical center to improve patient and staff safety, as well as operational outcomes. Poisson regression was performed to determine differences between workplace violence events, falls, 30-day emergency department (ED) revisits, and hospital readmissions, comparing the baseline period to the intervention period.Results: There were 321 patients discharged in the baseline period and 310 during the intervention period. Workplace violence events decreased by 65.6% (incidence rate ratio [IRR] 0.34, 95% confidence interval [CI] 0.20-0.57, p < 0.001) after implementation of the clinical microsystem when compared to the baseline period. The rate of ED utilization at 30 days postdischarge also decreased from 30.6% at baseline to 21.0% postintervention (adjusted odds ratio [aOR] 0.60, 95% CI 0.42-0.87, p = 0.006). No differences were detected in falls and 30-day readmissions.Conclusion: For patients with concurrently decompensated medical and psychiatric conditions, the incidence of workplace violence and postdischarge ED utilization can be improved by creating a clinical microsystem that integrates changes to both the physical environment and teamwork processes.

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Details

Title: Subtitle: Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients
Creators: Stephen J. Harder - Univ Texas Southwestern Med Sch, Div Hosp Med, Parkland Mem Hosp, Dept Internal Med, Dallas, TX USA
Henriette Mathis - Parkland Mem Hosp & Affiliated Inst, Medsecure Unit, Dallas, TX USA
Maryam Warsi - University of Washington
Kehinde Odedosu - Parkland Mem Hosp & Affiliated Inst, Med Consult Serv, Dallas, TX USA
Rebecca C. Hanna - Univ Texas Southwestern Med Sch, Dept Psychiat, Dallas, TX USA
Eugene S. Chu - Univ Texas Southwestern Med Sch, Hosp Med, Parkland Mem Hosp, Dept Internal Med, Dallas, TX 77030 USA
Resource Type: Journal article
Publication Details: Joint Commission journal on quality and patient safety, Vol.49(1), pp.53-61
DOI: 10.1016/j.jcjq.2022.10.004
PMID: 36456435
NLM abbreviation: Jt Comm J Qual Patient Saf
ISSN: 1553-7250
eISSN: 1938-131X
Publisher: Elsevier
Number of pages: 9
Language: English
Date published: 01/01/2023
Academic Unit: General Internal Medicine; Internal Medicine
Record Identifier: 9984772257902771

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