Safety Grades- Stratifying Risk in an Inpatient Setting for Pediatric Patients

Abstract: Background/Significance:
Significant numbers of children continue to be admitted to pediatric medical units while awaiting psychiatric placement, though the prevalence is challenging to quantify (McEnany, et al.). The physical space of medical hospital rooms often creates safety concerns for patients with behavioral challenges (Feuer, et. al).


Methods:
To maintain safety for patients, families and hospital staff, while balancing the need to provide a least restrictive therapeutic space, a Safety Grades system was designed and implemented. The goal of this system is to stratify restrictions based on patient risk to decrease limitations on patients at lower risk of unsafe behaviors during hospitalization while continuing to promote overall safety and well-being.


Discussion:
When patients are admitted to board under behavioral observation for safety concerns on the pediatric medical unit, an environmental safety checklist is first used to prepare the physical space. Then, patients are assigned to one of two categories of behavioral risk. Each category outlines guidelines for items permitted in the room, as well as other behavioral recommendations related to patient clothing, allowable activities, recommended linens and utensils, and access to electronics. Through this risk-informed systematic approach, patients receive more standardized care in the least restrictive way possible, and primary teams learn how to stratify risk with psychiatric support.
Conclusions/Implications:
It is our hope that this system may be adapted to fit the needs of similar hospital settings that care for pediatric patients awaiting
psychiatric placement.