Background: Challenging patients exhibit disruptive behaviors that lack conformity with normal work flow. Examples of such behaviors include drug seeking, violence, non-compliance, exchanging drugs with visitors, unauthorized departure from hospital premises, etc. Patients engaging in these types of actions commonly over-utilize health care resources and create conflicts between different providers who are not adequately trained or informed about the legal boundaries that govern these interactions. Our response was developing a multidisciplinary committee that identifies and designs a specific plan for each behavior. The committee is composed of physicians, nurses, case managers, social workers, emergency department physicians, and risk management. Individualized complex care plans are developed for each patient based on the behavior(s) he/she exhibited. The plans are reviewed and approved by legal counselors. The patients are asked to sign a form to confirm their understanding of the treatment plans and implications of non-adherence. We hereby present the impact of these complex care plans on the rate of emergency department visits and admissions during a 1-year time period before and after the implementation of each plan.
Purpose: Implementation of multidisciplinary plans is effective in reducing emergency department visits and admissions by patients exhibiting challenging behaviors.
Description: Following IRB approval for this quality improvement study, eleven consecutive patients received this intervention. Frequency of emergency department visits and admissions before and after implementation of the plans were compared using Wilcoxon Signed Rank Test.
Conclusions: The mean number of admissions before and after the plan is 17 and 5.8, respectively (p 0.002) and the mean number of emergency department visits is 11.7 and 6 respectively (p.04).
Thus developing a multidisciplinary committee to deal with challenging patients is an effective way of reducing emergency department utilization and unnecessary admissions. Given the widespread prevalence of challenging patients, future physicians must receive structured training on the subject. We believe that this multidisciplinary approach can be expanded to other training programs.