PROBLEM: Across acute care hospitals, a sub-population of patients admitted for medical/surgical care exhibit challenging behaviours due to dementia, delirium and/or co-morbid mental illness. These challenging behaviors may include agitation, aggression, resistance to care and impulsivity. These symptoms may impede the delivery of urgent medical/surgical care and increase potential safety risks to both patients and staff. PRACTICE: To improve outcomes for this complex population and front-line staff providing care, Mount Sinai Hospital’s Department of Psychiatry developed the SAFE PATIENTS/SAFE STAFF Program. The program enables proactive psychiatric support for patients meeting specific high-risk/high-needs criteria in conjunction with interprofessional capacity building and a standardized clinical response. A critical and innovative component of the program, submitted for consideration to ACCREDITATION CANADA, is our automated electronic medical record-driven behavioural reporting system, used to identify behaviourally complex patient care situations. Named the ‘BOOST’ REPORT because it triggers our Behavioural Outcome Optimization Support Team to respond, the report generates a daily list of hospital patients with electronic medical record documentation meeting high-risk/high-needs criteria. IMPACT: This proactive report system was developed after an environmental scan and critical incident reviews highlighted that there are often early warning signs and patient profiles that indicate a patient may require extra support in advance of a formal request for psychiatric consultation. Our creation and use of the ‘BOOST’ Report has resulted in both improved patient care and safety for both patients and staff. It has led to reduced burden for staff in the care of patients with behavioral disturbances and increased patient/family satisfaction. This type of automated report can be easily adapted to support other hospital improvement projects that require specialized patient case-finding.

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