405-O. Guesting Area: An Innovative Approach to Holding the Psychiatric ED Patient

tools for appropriate patient placement; (3) evaluate the viability of the collaborative relationship between the DeDSAMH and CCHS; and (4) determine if an inverse relationship exists between voluntary and involuntary admissions. doi: 10.1016/j.jen.2005.07.028 405-O. Guesting Area: An Innovative Approach to Holding the Psychiatric ED Patient. Beth Winokur, RN, MSN, CEN, Amy Waunch, RN, MSN, FNP, CEN, St Joseph Hospital, 1100 W Stewart Dr., Orange, CA 92683 Clinical Topic: With ED volume increasing, the number of patients presenting to the emergency department with psychiatric problems is growing. Concurrently, the quantity of available inpatient psychiatric beds is decreasing, which is contributing to an increased length of stay in the emergency department. These issues lead to expanded utilization of staff and resources and delays in the initiation of definitive psychiatric care. The purpose of this project was to relocate psychiatric patients from the emergency department to a safe, therapeutic area while freeing ED services for other patients. Implementation: A temporary holding area located within the behavioral health services department of a suburban community hospital in Orange County, Calif, was created to house psychiatric patients awaiting admission or transfer. The concept, which was named the Guesting Area, was developed by a multidisciplinary team of nurses and physicians from the behavioral health services and emergency departments, security personnel, and individuals from hospital administration. The team sought consultation and approval from the Orange County Departments of Health and Mental Health. Implementation began after locating and furnishing an appropriate area within the behavioral health services department. Policy and procedures, documentation forms, and tracking methods were developed, and education was provided to staff of both the behavioral health services and emergency departments. Although housed temporarily in the behavioral health department, the patients remained assigned to the emergency department. Evaluation of the Guesting Area is ongoing and involves staff feedback, chart reviews, and tracking of staffing needs, as well as risk issues, including violence and elopement. Outcomes: The Guesting Area opened March 2003. Outcome tracking included the number of hours security personnel who were needed in the emergency department to watch over psychiatric patients, which decreased from 347 hours per month prior to implementation of the Guesting Area to an average of 65 hours per month after the program was established. At this time, attempted or actual elopements from the Guesting Area have been nonexistent, which compares to an average of 5 attempted or actual elopements that occurred each year prior to the program. In addition, feedback from ED staff regarding the Guesting Area has been very positive. Recommendations: This project provides an innovative solution to a problem that confronts many emergency departments. In the current state of ED overcrowding and increasing numbers of psychiatric patients, the Guesting Area decreased the length of stay for psychiatric patients in the emergency department and June 2006 32:3 freed resources for other patients seeking emergency care. Future research activities involve obtaining additional outcome measures, such as patient and staff satisfaction and resource utilization. doi: 10.1016/j.jen.2005.07.029 406-O. Establishing the Need for Implementing a Pediatric Sexual Assault Response Team Program. Barbara Davis, RN, BSN, CEN, Charlotte Buckenmyer, RN, BS, MS, CRNI, Gina Sierzega, BA, MA, Elizabeth Evans, DO, Lehigh Valley Hospital and Health Network, 17th & Chew Streets, Allentown, PA 18104 Clinical Topic: In 1998, this emergency department implemented a Sexual Assault Forensic Examiner (SAFE) program for patients 12 years and older. Analysis of data between January 2001 and December 2004 revealed that, in addition to the 314 patients aged 12 years and older who were treated for sexual assault, 77 patients aged 11 years and younger also were treated. On average, pediatric patients aged 11 years and younger represent 18% to 23% of all sexual assault cases annually in this emergency department. In response to the number of pediatric patients younger than 12 years who need treatment for sexual assault in the emergency department and the lack of a specialized program to address their specific needs, this institution implemented a pediatric sexual assault program. Implementation: On July 1, 2004, a pediatric Sexual Assault Response Team (SART) consisting of 3 emergency physicians, 3 pediatricians, and 4 trained SART nurses was initiated. Nurses received training during a 2O-day pediatric sexual assault education session that was offered through an outside organization. SART nurses were able to serve as SAFEs for the 12 year and older population as well. Following implementation of the SART program, all sexual assault patients who presented to the emergency department were asked a series of questions by the triage nurse, who then paged a SAFE nurse. The SAFE nurse used a carefully designed algorithm to determine the patients’ care path. A team, comprised of a SART physician and nurse, treated each patient; however, plans are in process to have SART nurses treat pediatric patients independently. Lastly, support was provided to SART team members through monthly meetings and adequate staffing to ensure that each member’s on-call rate remained low. Outcome: Between July 1 and December 31, 2004, the SART team treated 14 sexual assault patients younger than 12 years. In addition, 118 sexual assaults among patients 12 years and older were treated in 2004. ED physicians and nurses have indicated great satisfaction with the SART program. Plans are being developed to implement an internal course to train nurses and physicians on the SAFE and SART programs. Recommendations: Analysis of data from the institution’s SAFE program revealed a considerable number of pediatric sexual assaults in the emergency department. Although pediatric patients received appropriate care prior to implementation of the SART program, this population benefited from a specialized team trained to care for the pediatric patient. As a result, it is recommended that hospitals implement a combined SAFE and SART programZone that generates a team to care for both pediatric and adult sexual assault victims. In addition, it is JOURNAL OF EMERGENCY NURSING 215