Emergency department (ED) pediatric psychiatric service structure, process, and outcomes

Nurses constitute the largest portion of clinicians directly involved in the triage and care of psychiatric patients in emergency departments (EDs). Exploratory studies have described nurse attitudes related to psychiatric emergency patients; however, very little research has addressed the influence of ED nursing care on psychiatric patient outcomes. Nurse and patient/family dissatisfaction with ED psychiatric services (EDPES) has been attributed to the disparity between psychiatric need and emergency resources. To correct such disparities, we must achieve a greater understanding of EDPES structure, process, and outcomes. This study addresses the current deficit by surveying nurses about the culture and climate within which pediatric psychiatric emergency services are delivered to shed light on the extent to which organizational context affects quality of care. Data sources including the Organizational Social Context Survey*(OSC), the PI's previously collected ED psychiatric services survey, and American Hospital Association were merged to test the conceptual model. The OSC targeted all full-time registered nursing staff who are regularly involved in the direct care of pediatric mental health patients at participating nonfederal hospital emergency departments within Virginia (n=69). A significant interaction of organizational context with other aspects of pediatric EDPES suggests the need for interventions targeted to improve ED nursing staff's perceptions of pediatric psychiatric service efficacy. Implications for future research will be discussed.

*Permission to use the Organizational Context Survey was provided by the University of Tennessee Child Mental Health Services Research Center.