Behavioral Intervention Team Improving Outcomes in Older Adults with Mental Illness: Retrospective Review of Outcomes on Med-Surg Units

Mentally ill older adults often exhibit behavioral disturbances, such as removing medical devices or wandering while hospitalized. Challenging behaviors can lead to sentinel events such as falls, elopements, or violence (Sledge et al., 2015; Wittink et al., 2020). Prevalence of psychiatric diagnoses in medical inpatients is between 20-40% (Chan et al., 2018; Jansen et al, 2018; Sledge et al., 2015), and more recently, has been estimated as high as 50% (Robbins-Welty & Gagliardi, 2023). These co-morbidities negatively impact mortality, length of stay (LOS), cost of care, use of restraints, and readmission rates (Chan et al., 2018; Jansen et al., 2018; Wittink et al., 2020). Patients with chronic mental illnesses have a higher risk for medical illnesses, with increased morbidity and mortality, and more frequent hospitalizations. Complicated alcohol withdrawal, neuroleptic malignant syndrome, cardiovascular emergencies, and severe eating disorders frequently require care (such as IV medications, wound care, and cardiac monitoring) that exceeds the capabilities of inpatient psychiatric units (Chan et al., 2018; Robbins-Welty & Gagliardi, 2023; Wittink et al., 2020). At the same time, behavioral symptoms create excessive demands on the medical team, and may adversely impact medical team engagement (Sledge et al., 2015). The traditional consultation-liaison model, though not standardized across all facilities, is the current approach to behavioral care needs in many healthcare systems. This approach is reactive, and consultations are sought when challenging behaviors or psychiatric symptoms emerge. Lack of consistency in care leads to missed opportunities, late requests, and delayed discharges. The interdisciplinary Behavioral Intervention Team (BIT) was implemented on the campus of Prisma Health Baptist Hospital in Columbia, SC to address and anticipate the needs for behavioral health support on medical units which often extended beyond a consult with a psychiatrist.