How to create an ED psych unit 'from scratch'
While the creators of the Psychiatric Transition Unit at Vanderbilt University Medical Center in Nashville, TN, could find no pre-existing models to emulate, the successful unit they created may now serve as a model for other EDs.
"We went with a very simple setup, focusing on protected rooms," says Brent Lemmonds, RN, the nurse leader who directed its creation and now supervises the staff.
They moved the light switches outside the rooms to prevent a patient from accessing electricity and harming themselves. All electrical outlets are covered. They used hard ceilings instead of tile, so patients couldn't use the ceilings as potential escape routes.
The general principle was that the rooms should be much safer than an ED exam room, which had cables, sharp corners, and other items a patient could "do mischief with," he explains. In addition, says Lemmonds, the room is furnished with "a very inexpensive vinyl couch" and chairs, which are bolted to the floor. "We added cameras outside so we could monitor the therapist and patient," he says.
Lemmonds offers advice for ED managers considering such a project:
• Have an emergency plan.
"We developed a 'rapid admission to the ED' plan, in case of a medical emergency," says Lemmonds. "The patient is going to be waiting there for nine hours, so even though they were medically cleared initially, anything can happen."
The plan includes having a stretcher and wheelchair available for rapid transfer "any time a patient exhibits signs of medical emergency or a major vital sign abnormality." The techs in the unit are cross-trained as ED "care partners." They know how to take vital signs and provide basic care in the ED setting, and they are accustomed to moving patients.
• Have a policy on smoking.
Mental health patients and drug-addicted patients frequently will ask to smoke, because they feel it calms them down, notes Lemmonds.
"We have a very liberal policy of providing patients with nicotine patches," he says, "and at times, to keep them calm, we will take them outside with an escort to have a smoke."
• Have direct phone lines to the police department.
"We had them installed in both hallways so in case of an agitated patient, we can get help immediately," says Lemmonds. The police department funded the direct lines, he says.
While the creators of the Psychiatric Transition Unit at Vanderbilt University Medical Center in Nashville, TN, could find no pre-existing models to emulate, the successful unit they created may now serve as a model for other EDs.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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