The strange noises, the bright lights, the unfamiliar setting, the constant busyness — these stimuli and more can take a toll on a patient’s mental well-being when they’re in hospital for a physical ailment.
“We know the hospital environment can trigger the patient’s mind and cause them to become confused; delirium is a major issue,” said Tendayi Bruce Dziruni, mental health nurse at Alfred Health and PhD scholar at the Deakin Centre for Quality and Patient Safety Research, Deakin Institute for Health Transformation.
Recognising the early signs of a patient’s mental state deterioration (MSD) is complex. The volatile nature of MSD in acute hospital settings is a safety risk for frontline staff, care providers and hospital administrators, and it’s a distressing experience for patients and their families.
Australian healthcare standards require organisations to have systems for managing MSD, such as Victoria’s Code Grey/Black procedures. However, staff typically initiate these reactive, safety-first responses to aggression, violence, and weapon threats when the situation is a crisis, and it’s too late to positively influence outcomes.
Seeking an alternative to the mandated Code Grey system, Dziruni and colleagues evaluated a proactive rapid response system aptly named DIvERT for De-escalation, Intervention, Early Response Team. Piloted at Melbourne’s Alfred Hospital, the evaluation findings were recently reported in the Journal of Advanced Nursing.
With a collaborative multidisciplinary team intervening promptly to early signs of MSD — which are better recognised and managed with tailored training — the DIvERT system aims to support improved patient care, safety, staff confidence and system efficiency.
“When staff used the traditional Code Grey system, there were repeated patient crises, making their MSD much more difficult to manage. In contrast, using DIvERT early may have prevented risks from escalating to more interventions. It’s reassuring to know patient outcomes are better when DIvERT is used,” said Dziruni.
“If our evidence on DIvERT can start important conversations among nurses, clinicians, hospital administrators and policy makers about better care for MSD, then we may drive new ways of managing the challenges of MSD across the hospital environment.”
Read Tendayi Bruce Dziruni’s paper titled: A Realist Evaluation of a Rapid Response System for Mental State Deterioration in Acute Hospital Settings.
Read more about Tendayi Bruce Dziruni’s research.
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