behavioral

Comparing notes on the Sickle Cell/General Medicine unit (EP 6-7), are Behavioral Intervention Team members (l-r): Jessika Brasseaux, APRN; Mark Oldham, MD; and Chelsea Hinchey, APRN.


Being hospitalized can be stressful for anyone, but for patients with mental disorders, the illness, tests and treatments and unfamiliar people and environment can be even more overwhelming.

"Under stress, these patients may misunderstand their medical needs. They might decline potentially life-saving treatments, or even lash out at care team members who are trying to help them," said Hochang Lee, MD, a psychiatrist and director of the consultative and collaborative psychiatry service at the Saint Raphael and York Street campuses. "In the past, the primary medical team would call the attending consultation-liaison psychiatrist only when these patients reached a psychiatric crisis, such as self-injurious behavior, violence toward staff and other behaviors. It was very reactive, and often avoidable if the psychiatric issues were identified and addressed earlier."

To change the approach, Yale Psychological Medicine Service in 2008 launched a pilot program at Yale New Haven Hospital in which a psychiatrist was "embedded" with a medical unit. The psychiatrist rounded with medical team members to proactively identify patients requiring a psychiatric consult and ultimately ensured these patients received appropriate psychiatric care while being treated for their medical conditions.

The pilot program – the first of its kind in the U.S. – also helped prevent disruption to the patients' medical care, shortened length of stay and reduced the use of constant companions.

The program has since evolved to include two Behavioral Intervention Teams (BITs) that cover eight medical units at the York Street Campus. An additional BIT will begin covering four medical units at the Saint Raphael Campus in the fall. The teams include psychiatrists, APRNs, clinical nurse specialists and psychiatric social workers who provide consults to the primary medical team.

"The BIT members collaborate with nurses on the medicine units to provide support proactively," said Victoria Ogbejesi, APRN, patient service manager, Psychological Medicine Service. "This not only leads to better patient outcomes, it improves staff satisfaction."

For example, BIT members often support nurses in managing patients who are withdrawing from alcohol. In the past, a number of these patients would have gone to the intensive care unit.

The BIT program has been so successful at enhancing care, improving patient and staff satisfaction and reducing costs that other healthcare organizations, including the Johns Hopkins Hospital and Dartmouth-Hitchcock Medical Center, have adopted the BIT model, Dr. Lee said.

"One of the greatest benefits of the BIT program is the ability to advocate for mentally ill patients on the medical units," he said. "By getting involved early, we can identify behavioral barriers that might interfere with these patients' medical care."