PROJECT SUMMARY
Most emergency departments (ED) in the United States are poorly designed, organized and equipped to provide
safe and effective care for children with mental and behavioral health (MBH) conditions. Safety concerns for
children with MBH conditions in the ED include delays in care, lack of appropriate psychiatric consults during
visits, patient self-harm, harm against others or the environment, and involuntary restraint use resulting in patient
and staff injury. A systems approach is needed to address the many latent conditions in the ED that impact MBH
patient and provider safety. The purpose of the proposed ‘Realizing Improved Patient Care through Human-
centered Design for Pediatric mental and behavioral health in the Emergency Department (RIPCHD.PED)’
patient safety learning lab (PSLL) is to develop and implement pediatric MBH health work systems in the ED that
promote safe, efficient and effective care by minimizing unnecessary stressors for patients while also improving
provider well-being. This PSLL will include a focus on the needs of children and their caregivers from minority
communities in order to address disparities in MBH care in the ED. Further, the PSLL will focus on rural and
urban EDs to ensure that proposed solutions address a range of resource constraints typically found in EDs
across the US. A multidisciplinary team from Clemson University, Prisma Health and University of South Carolina
School of Medicine will collaborate using a systems engineering approach involving in-depth problem analysis,
design, development, implementation and evaluation. The specific aims of this project include, Aim 1: Use
systems engineering methods to develop a shared in-depth understanding of the work system facilitators and
barriers involved in the pediatric MBH ED caregiving workflow, Aim 2: Design and develop human-centered work
systems for pediatric MBH patients in the ED that will improve access to timely MBH care, reduce adverse events
and improve efficiency for ED healthcare providers and Aim 3: Integrate, implement and evaluate innovative
interventions within pediatric MBH work systems in the ED that will improve outcomes for ED patients and
healthcare providers. The team will use a range of methods including workflow analysis, journey mapping and
space syntax analysis to understand barriers and facilitators and identify opportunities for improvement. An
iterative design process will be used to design and develop solutions related to the physical environment, tools
and technology and tasks and workflow. This PSLL strongly aligns with AHRQs mission by focusing on safety,
quality, equity and access to appropriate mental health care for children with mental and behavioral health
conditions. The project will support AHRQ’s strategic focus on children as a priority population by contributing
to all 6 goals outlined in AHRQ’s strategic plan. Further, the PSLL will include a focus on underserved rural
populations as well as children from Black and Latino communities. RIPCHD.PED PSLL will be the most
comprehensive effort ever undertaken to improve work systems for pediatric MBH in the emergency department.
