Children and teenagers presenting to emergency rooms with behavioral health crises sometimes wait hours to days for a bed in a psychiatric unit or facility. Children’s Medical Center in Dallas is trying to make that stay less stressful for patients and their families by incorporating technologies such as mood lighting, projected images of calming scenery and an interactive touchscreen allowing patients to draw, play music or games.
Also, this year, the University of Maryland Children’s Hospital in Baltimore opened a new inpatient psychiatry unit for patients ages 5-17 featuring nature themes, special lighting and patients’ choices of relaxing sounds. In both cases, clinicians aim to create more calming environments to help de-escalate behavioral and mental health crises.
The Dallas hospital opened three “Philips rooms” (named after Phillips, their health care technology partner) in their emergency department in June 2021. A fourth is scheduled to open in 2022.
The inspiration behind these rooms
Inspiration came partly from two memorable patient experiences, said Keri Kaiser, senior vice president and chief marketing and experience officer for Children’s Health, during a recent webinar hosted by Becker’s Healthcare. Kaiser was in the ED one day when she saw a young girl, who was extremely violent, being held in a bare room alone. She was in the custody of Child Protective Services and had no parents or guardians with her. Because of her aggression, staff limited their interaction while hoping to find a placement in a psychiatric facility. On another occasion, Kaiser’s friends told her that their daughter, who was being held in the ED, was physically safe but felt helpless being stuck in a bare room.
Shortly after, Kaiser and others with the health system were scheduled to visit Philips to see what technology advancements could be brought to the neonatal intensive care unit. The company has worked with hospitals to offer what it calls the “ambient experience” — a variety of room designs, dynamic lighting, image projection and calming sounds to make waiting areas, and procedure and recovery rooms more pleasant. As Kaiser viewed these options, she asked if they could also be used for behavioral and mental health patients in the ED.
Geneva Burnap, M.B.A., R.N., N.E.A.-B.C., a nurse, and senior director for emergency services at Children’s Health, said during the webinar that she initially got some pushback about creating these rooms, because behavioral health holds only made up 4.5% of their patients. But studying analytics, she and her colleagues found that some 20% of care hours were spent on these patients.
A customizable experience
In the Philips rooms, patients and their families can customize the ambience choosing one of several themes such as a night sky with a pulsing star or a field with a floating butterfly, which are projected on the walls. Nurses help coach the patients through breathing techniques by focusing on that star or butterfly. Each theme comes with a set of sounds to immerse the patient.
The rooms also feature a window-sized interactive touchscreen on one wall by a Netherlands-based company called Recornect, which contains apps that allow patients and their providers or family members to draw or play games like tic tac toe or whack a mole. The device, designed for use in high-security spaces features a steel frame surrounding a glass panel, situated flush with the wall. All medical equipment is maintained behind a retractable door in the rooms to protect patients from potential self-harm. A smaller touchscreen panel outside the room allows ED staff to control all features in the room if necessary.
What is the impact of therapeutic rooms?
The Children’s Health team has some studies planned to evaluate the rooms’ impact. “The goal is to learn if the technology in the rooms helps improve de-escalation of mental health emergencies, provides active relaxation, reduces the use of sedation and restraints that is sometimes needed for behavioral health emergencies, and reduces the length of stay at the emergency room,” Burnap said.
She also shared an anecdote about one aggressive patient who had to be restrained on a stretcher because she was being destructive. A psychiatrist recommended she be placed in one of the Philips rooms. Within two hours, she had calmed to the point that the team could remove the restraints, and she was able to be discharged home that evening.
As the data accumulates, hospital staff may incorporate some of the technologies into other potentially high-stress areas for patients, including the neonatal ICU, cancer center and heart center, Kaiser said.
In Baltimore, the University of Maryland’s new 16-bed child and adolescent psychiatry unit was designed architecturally and clinically to deliver “trauma-informed” care for children ages 5-17, according to an article in JMore magazine.
The therapeutic unit features soothing colors and nature themes, curved walls, and lighting that mirrors circadian rhythms to promote restful sleep. An immersive sensory room is designed to help children regulate their emotions. Audio-control switches allow them to choose calming sounds to play like music, nature sounds or running water. To maximize staff and patient interactions, work such as documentation and team conversations occurs out of sight from direct patient care areas.
The unit’s approach is to give young patients the choices, control and calm environment that is often taken from them during trauma-filled environments or events, psychiatrist Jill RachBeisel, M.D., told the magazine.
“When a child or adolescent experiences a mental health crisis that requires inpatient care, they are, in fact, ripped away from all that is familiar to them,” RachBeisel said in the article. “We want to give these youngsters a physical space that is warm and welcoming where they can feel safe, express themselves and have control over their environment.”
The average stay in the unit is five to six days, with a focus on managing reactions, developing coping skills and learning to solve problems, according to the article.
Journalists writing about patients with behavioral or mental health crises experiencing long stays in hospitals may want to ask medical centers what they are doing to enrich the environment to improve patients’ experience, either through high-tech or low-tech offerings.