The Impact of Constant Observation in Pediatric Mental Health Emergencies: Perspectives from Emergency Department Staff.

BACKGROUND: Emergency departments are critical care settings for children in mental and behavioral health crises. Psychiatrists and psychiatric-mental health nurses collaborate with emergency department teams to manage safety risks for these patients, which often involves constant patient observation, particularly for agitated or suicidal patients. OBJECTIVE: This paper aims to understand emergency department staff's perspectives on constant observation of pediatric mental and behavioral health patients and the impact of this practice on emergency department workflows. METHODS: This qualitative study thematically analyzes 55 semi-structured interviews with members of the emergency department team, including patient observers, from four different hospitals. RESULTS: Eight themes were identified as impacting emergency department workflows and patient care. The most commonly mentioned themes included the impact of constant observation on emergency department workflow, situational awareness and clear sightlines to the patient, and compliance with constant observation-related organizational policies. CONCLUSIONS: Findings provide insights for optimizing the role of the patient observer, incorporating remote monitoring to increase patient safety, enhancing the emergency department physical environment to enhance the quality of care, optimizing patient outcomes, and maintaining a safe environment. This study's results support advanced psychiatric-mental health practice nurses and emergency and psychiatric-mental health clinical nurses in improving the quality of care and safety for this vulnerable population.