615 - A Quality Improvement Initiative to Reduce Medical Screening Labs for ED Patients with Mental and Behavioral Health Concerns

Publication Number: 1592.615

Morgan Weyant-Cheeseman, UTSW/Children's Medical Center Dallas, Dallas, TX, United States; Srivastava Geetanjali, University of Texas Southwestern Medical School, Dallas, TX, United States; Brian Wagers, University of Texas Southwestern Medical School, Lewisville, TX, United States

Background: Patients presenting to the emergency department (ED) with acute mental and behavioral health (MBH) concerns frequently undergo routine laboratory testing for medical clearance despite limited evidence supporting this practice. As part of the Improving Mental Health Processes, Workflows & Responses (IMPWR) initiative within the American Academy of Pediatrics Pediatric Acute & Critical Care Quality Network, our hospital undertook a quality improvement (QI) project to reduce non–evidence-based lab testing for MBH patients. Our hospital does not have an inpatient psychiatric facility, so all patients must be transferred.

Objective: To reduce the proportion of patients (ages 12–18) presenting with MBH concerns who receive routine medical screening laboratory tests and evaluate the impact on LOS. Our goal was to decrease screening labs for psychiatric transfers from 100% to 80%.

Design/Methods: Using a Plan–Do–Study–Act (PDSA) framework, this single-site QI project was implemented from July 2024 through September 2025. Collaboration with external psychiatric facilities was secured (three facilities approved participation in July 2024, one in November 2024, and two in January 2025).
Interventions included:
• Development of a standardized screening protocol co-endorsed by receiving facilities.
• Implementation of an “dot phrase” to standardize documentation and promote adherence.
• Education at division meetings (July 2024, October 2024, February 2025).
• Scribe training (November 2024, February 2025).
• E-mail reinforcement (August 2024, December 2024, July 2025).
• Offering Maintenance of Certification (MOC) Part 4 credit for quiz completion (Aug–Sept 2025).

Twenty charts were randomly sampled monthly to assess adherence and lab utilization for all MBH patients and transfer subsets. LOS data was obtained for all patients with MBH concerns.

Results: Baseline unnecessary labwork occurred in 15–60% of encounters, decreasing to 0–25% post-implementation. Adherence increased from 11% to 80% for all MBH patients and 50% to 100% for transfers. Mean LOS improved from 637 to 570 minutes for all MBH patients (p = 0.02) and from 964 to 868 minutes for transfers (p = 0.0075).

Conclusion(s): Through multi-phase education, workflow redesign, and collaboration with external psychiatric facilities, our hospital reduced unnecessary lab testing and achieved statistically significant reductions in LOS for patients with acute MBH concerns. This project demonstrates a scalable model for hospitals without onsite psychiatric units to standardize evidence-based MBH medical screening and improve ED efficiency.

Emergency Department Length of Stay (LOS) for Patients with Mental and Behavioral Health Concerns, June 2023–June 2025
LOS Chart All Patients.pdf

Emergency Department Length of Stay (LOS) for Patients with Mental and Behavioral Health Concerns, Inpatient , June 2023–June 2025
LOS Chart Inpt .pdf

Standardized Medical Clearance "Dot Phrase” for MBH Patients
Dot Phrase.pdf