Connie Christian, MBA, CPHRM
Facility Risk Management and Patient Safety Advisor

Risk Assessments in In-patient & Emergency Settings

In our age of segmented care, continuity of care is key in ensuring patients receive the most appropriate care not only for their acute condition but also for managing self-harm issues. In mid-July, the Centers for Medicare and Medicaid (CMS) issued guidance to hospitals on ligature risks and assessments in all in-patient and emergency settings. The guidance is aimed at hospital compliance; however, physicians and healthcare providers play an important role in promoting appropriate care in a safe environment.

The Impact of Acute Mental Health Events

When treating an acute mental health event, emergency providers, hospitalists, and attending physicians benefit from the information the ambulatory provider may have on a patient’s mental health or emotional status. Patients present to the Emergency Departments (ED) and in-patient units for many conditions. Acute medical issues impact how the medical staff perceive their mental health. In such situations, harm to self or others—and its impact on patient safety—may not be the highest initial priority for the responding healthcare team.

Context-specific Evaluation of Acute Mental Health Condition

Patients should be evaluated in relation to their acute medical condition. For instance, a patient in the post-partum unit will require a different risk assessment and resources than those in the trauma post-surgical unit or the emergency department. Healthcare providers must advocate for individualized and specific mental health assessments and treatment options while still operating within the realm of generalized hospital policies and safety strategies to ensure patients receive appropriate quality care in a safe environment.

Information sharing through a health information exchange or shared electronic health record system can allow this critical information to flow between the practice and hospital settings when the patient needs it the most.

Use CMS Guidance to Devise an Appropriate Risk Assessment Strategy

While all hospitals are expected to implement a patient risk assessment strategy, it is up to the individual facilities and systems to determine the appropriate strategies. The guidance clarifies that hospitals can demonstrate compliance with certain patient safety standards by conducting appropriate patient assessments, adequately staffing and monitoring units, and mitigating environmental risks through risk assessments.

The CMS Guidance

The CMS Guidance states:

 “…hospitals have a regulatory obligation to care for patients in a safe setting under the Medicare Hospital Conditions of Participation at §482.13(c)(2). The intention of this requirement is to specify that each patient receives care in an environment that a reasonable person similarly situated as the patient would consider to be safe. Additionally, this standard is intended to provide protection for the patient’s emotional health and safety as well as his/her physical safety. Respect, dignity, and comfort would also be components of an emotionally safe environment.”

To review the guidance in its entirety, see https://www.cms.gov/files/document/qso-23-19-hospitals.pdf.