WDH 2020-2021 Nursing Report - Flipbook - Page 13
Inpatient Behavioral Health
Case Worker
There has been an increase in volume and complexity
of patients admitted to the hospital with diagnoses of
mental health disorders, substance use disorders, and
dementia. This increase has been present for several
years but has been exacerbated by the pandemic and the
aging population of our community. At the same time
as volume and complexity has increased, community
resources have decreased. The lack of adequate inpatient
psychiatric beds and long-term care beds has resulted
in patients having longer lengths of stay in our hospital.
The complexity of the patient presentation, coupled
with their longer stays, can compromise optimal care
of the patient; increase staff stress and burnout; and
increase the risk of workplace violence/injury. A recent
analysis of workplace violence resulting in staff injury
at WDH identified a need for increased patient and
staff support, and increased care planning for the more
complex behavioral health and dementia patients. After
reviewing the data, Sheila Woolley, CNO, and Kellie
Mueller, AVP of Behavioral Health Services, discussed
the possibility of adding an inpatient behavioral health
case worker to help support staff better by working with
the team to assess the respective patient, develop care
plan with inpatient team and assist with complex care
huddles. A proposal was developed and presented to
Peter Walcek, CFO, depicting the increase in violence and
the hypotheses that adding a case worker would improve
outcomes. A dedicated behavioral health case worker on
the inpatient units was implemented in November 2021to
provide such services to patients, families, and the direct
care team. The case worker will provide “at the elbow”
support to the medical care team to include behavioral
health clinical guidance, education and consultation;
conduct behavioral health assessments and followup assessments for disposition planning and ongoing
care plan development; assist and guide care teams in
the implementation of care plans; identify educational
needs of the care team; and advocate for care team peerto-peer support to increase resiliency and address the
emotional impact challenging patients can have on the
interdisciplinary care team.
One example of this new role making an impact was
with a behavioral health pediatric patient on Women
and Children’s in November 2021. The patient became
agitated, attempting to barricade himself in the bathroom
in his room. There was discussion about administering an
IM mediation and potentially needing to put the patient
into restraints. The case worker was able to immediately
huddle with the care team, including security, and
devise a different approach. The case worker met with
the patient, was able to de-escalate the situation and
convince him to take a PO medication. This resulted
in no need for “hands-on” with the patient, no IM, and
no restraints. This provided for a better experience for
the patient and his family and eliminated a potential
employee harm situation by avoiding “hands-on”.
2020–2021 Nursing Annual Report
13