What Do We Do When Things Fall Apart? Rapid Creation of a Pilot Psychiatric Intensive Care Unit in Response to Increased Acuity on a Psychiatric Inpatient Unit for Children and Adolescents

ABSTRACT

The past two decades have seen a sharp increase in suicide and psychiatric hospitalizations for children and adolescents. While many youth are served well in the inpatient psychiatry setting, a subset of this population does not stabilize during an average length of stay and with the typical therapeutic interventions provided by an inpatient unit. This study examines the creation of a psychiatric Intensive Care Unit (ICU) for patients who exhibited the most severe and acute mental illness, self-injury, and aggressive behaviors on a child and adolescent psychiatric inpatient unit. The ICU was created in response to increasing numbers of restraints, assaults, and patient and staff injuries in the months preceding creation of the program and potential contagion effect of safety issues amongst patients. Post-implementation, nominal reductions in safety metrics were found in both the ICU and general milieus for patient and staff injuries and assaults. Nominal decreases in restraints and self-injury were also found in the ICU. Significant decreases in property destruction were found in both milieus and restraints significantly decreased in the general milieu. In addition, patients who participated in the ICU milieu were less likely to be re-admitted to an inpatient psychiatric unit following hospitalization. Overall, the ICU was well-received by staff and patients’ caregivers.

Acknowledgments

We would like to thank the staff of the Psychiatry and Behavioral Medicine Unit at Seattle Children’s Hospital for their work with severely mentally ill youth and willingness to participate in the development and creation of the Intensive Care Unit. Specifically, we would like to acknowledge and thank Chris Sogn, LICSW who volunteered to be the therapist for the patients in the ICU. We would also like to thank William Pelham III, PhD for his work in the design, development, and early implementation of the ICU.

Finally, we would like to acknowledge and thank the patients and families who agreed to participate in this unique and new programming, without them, we would not have been able to implement this program.

Disclosure statement

The Seattle Children’s Hospital Institutional Review Board provided a waiver for this chart review study.

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.