Nashville, TN – Pediatric emergency departments across the country are facing a growing crisis in behavioral and mental health, with increasing numbers of children arriving in acute distress. But at Monroe Carell Jr. Children’s Hospital at Vanderbilt, a new, comprehensive care model is showing significant promise, reducing wait times, improving safety, and offering more individualized support for young patients. The hospital’s innovative approach, which prioritizes communication and specialized expertise, has garnered national recognition and offers a potential blueprint for other children’s hospitals grappling with similar challenges.
Over the past decade, Vanderbilt’s pediatric emergency department has seen a marked increase in visits related to behavioral and mental health concerns. This surge led to a corresponding rise in “behavioral health boarding,” a situation where children wait for extended periods in emergency rooms or general inpatient units even as awaiting placement in a psychiatric facility. Recognizing the detrimental effects of these delays on both patients and staff, hospital leadership established a Behavioral Health Taskforce in 2022 to streamline care and improve outcomes. This taskforce, comprised of clinical and quality improvement leaders, a project manager, and an executive sponsor, quickly began implementing changes based on quality improvement processes.
A cornerstone of the new model is the implementation of twice-daily behavioral acuity huddles. These brief meetings bring together frontline staff – nurses, social workers, child life specialists, psychiatrists, psychologists, and hospital medicine providers – to discuss patient needs in real-time. “We have been particularly deliberate in our actions,” explained Heather Kreth, PsyD, associate professor and director of Acute Behavioral Health Services at Monroe Carell. “We were able to develop and refine workflows, communication practices and strategically place expert staff across our pediatric enterprise to develop sure we are doing as much as possible to provide individualized care for patients and improve safety.” The huddles facilitate proactive planning, improve situational awareness, and allow teams to anticipate challenges, particularly during shift changes and overnight hours.
Significant Improvements in Patient Care
The impact of these changes has been substantial. According to hospital data, the new model has led to a 78% reduction in behavioral health boarding admissions. The average length of stay for patients requiring behavioral health support has been shortened by more than 50%, and the use of restraints has decreased by 67%. These improvements not only benefit patients but also alleviate pressure on hospital resources and staff.
Ashley Ried, MMHC, BSN, RN, Magnet program director at Monroe Carell, emphasized the importance of a collaborative, multi-disciplinary approach. “Creating a robust structure to align multiple departments and disciplines across emergency, inpatient, perioperative, and ambulatory services has been essential in collaboratively improving the care we provide to our patients with mental and behavioral health needs,” she said.
Expanding Support with Specialized Teams
In 2023, Monroe Carell further enhanced its behavioral health services with the introduction of two new initiatives: the Behavioral Emergency Support Team (BEST) and the integration of a board-certified behavior analyst (BCBA) into clinical huddles and patient care. The BEST team responds to acute behavioral events in the inpatient and emergency room settings, providing de-escalation support. The addition of a BCBA has proven particularly valuable, offering real-time consultation to staff, helping them adapt care plans, and implementing individualized behavioral strategies. The BCBA also provides training on safe and compassionate care for neurodiverse patients.
“If you’re talking about behavioral interventions that can be targeted for severe problem behaviors, that really does benefit from someone with true expertise in behavior and intervention,” Kreth stated. “Our BCBA is making a significant impact on the care of kids.”
National Recognition and Future Directions
The success of Monroe Carell’s innovative care model has not gone unnoticed. The Children’s Hospital Association (CHA) recently recognized the hospital’s efforts, inviting Vanderbilt representatives to present at the CHA Annual Leadership Conference and featuring the new model in an article on their website. This recognition underscores the growing demand for standardized, collaborative approaches to pediatric behavioral health care.
The hospital’s experience highlights the critical role of clear communication, specialized expertise, and a commitment to aligning teams around common goals. As Kreth noted, “If you’re trying to do things in isolation with kids across different teams and nobody is talking to each other, things are going to fall through the cracks. This group makes sure everyone has a voice in behavioral health care and we keep this work moving forward.”
Monroe Carell Jr. Children’s Hospital at Vanderbilt will continue to refine and expand its behavioral health services, with ongoing evaluation of the BEST team and BCBA integration. The hospital plans to share its learnings with other institutions, contributing to a broader effort to improve the mental and behavioral health of children nationwide.
Disclaimer: This article provides information about medical practices and is not intended to provide medical advice. Please consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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