Spectrum Health emergency departments change medical clearance process
BIG RAPIDS — Patients needing mental health assessment after visiting Spectrum Health emergency departments with behavioral health complaints will get definitive treatment sooner after a recent change in how sobriety is measured.
After ruling out any medical-only issues, and when acute alcohol use is suspected, a patient can now be deemed clinically sober using the evidence-based Hack’s Impairment Index (HII) instead of waiting for their blood alcohol limit (BAL) to drop to the legal limit required to operate a motor vehicle.
The change will reduce unnecessary testing, reduce patient length of stay and reduce costs while waiting for alcohol metabolism.
“It’s a huge opportunity to improve care and reduce costs,” said Dr. Phil Stawski, emergency department medical director of Spectrum Health United and Kelsey Hospitals.
Stawski said for habitual alcohol users, waiting hours for their blood alcohol level to drop can actually harm patients as alcohol withdrawal can be life threatening.
Using the Hack’s test takes minutes, versus waiting hours or even a day for an alcoholic’s BAL to drop below the legal driving limit.
“If they’re there for a behavioral health complaint, we can use clinical sobriety as a measure for them to have their social work consult initiated and to provide whatever definitive psychiatric care they need without precipitating withdrawal symptoms,” he said.
The psychiatric complaints can include symptoms of hallucinations, paranoia, depression, anxiety, suicidal ideation or attempt, and mania.
The Hack’s Impairment Index measures gross motor function, mental activity, speech, tracing curve, eye movement and finger to nose testing. A HII score of less than four deems the patient as clinically sober and once medially clear, the patient can undergo disposition planning and coordination of post-acute care by hospital and community social workers and mental health clinicians.
The new protocol for Spectrum Health emergency department staff took effect December 1 in regional hospitals after implementing it at Spectrum Health Butterworth and Blodgett Hospitals this fall.
Beth Kuik, a Spectrum Health care management clinical supervisor who leads social workers at Butterworth and Blodgett hospitals, said the new process has led to more responsive care for patients.
“With the utilization of the Hack’s tool, we have been able to assess patients, create individualized discharge plans with community agencies and ultimately meet the patient’s needs in a more timely fashion,” she said,
“When the Hack’s Impairment Index is used in the ED setting, it is the springboard for a successful discharge plan,” she said. “When we assess that the patient’s clinical symptoms of intoxication trending down and stabilizing, this allows the entire treatment team to see that the patient has approached clinical sobriety.”