The Behavioral Health Experience solution is a first-of-kind adaptive environment for pediatric behavioral health patients in the Emergency Department (ED). Many adolescents seeking mental health care end up in their local ED as a last resort and experience 'psychiatric boarding' – held for days or even weeks in a secure but empty room while in a depressed, agitated or psychotic state. This isolation and loss of control while waiting for services in the community exacerbates the psychological stress on patients and can cause their condition to worsen.

The unique solution humanizes the experience of receiving mental health care in the Emergency Department. By integrating a specialized touchscreen with ambient room technology and therapeutic content, ED exam rooms are transformed into ultra-tunable environments that can help improve care delivery. Patients can rapidly de-escalate, begin therapy faster, and connect with staff in new ways.

Design Innovation

Pediatric behavioral health volumes have increased dramatically in recent years, and the Covid-19 pandemic has exposed a mental health endemic. Clinical workers in the ED may not always be trained to manage behavioral problems. Families don't have a lot of options for what to do next and are ultimately left in limbo in the ED days on end. ED exam rooms are typically designed for short 2-6 hour stays and are often windowless and barren to ensure patient safety above all else.

The adaptive room solution empowers patients to transform their exam room into a therapeutic and immersive environment. The design is centered around a specialized Recornect touchscreen – an indestructible yet simple patient interface to control the room. The screen features games, music, TV, and video call capabilities. It allows for telehealth consults with therapists, enables positive distraction, and fosters 1:1 interaction with clinical staff. Instead of an environment that isolates, the solution engages.

Custom theme content was co-developed with pediatric psychologists to calm and guide patients with self-regulating and coping exercises. The projected content has embedded therapeutic elements such as a 'breathing star' designed to help patients practice de-escalation techniques during their stay.

Benefit to User

The design benefits patients, families, and the clinical staff members who care for them. The audio-visual technology and specially designed imagery help to calm and coach the widest spectrum of pediatric patients, including suicidal-depressive, autistic, and violent adolescents ranging from ages 5-18 years old. Patients can personalize the ambience of the room to suit their individual preferences and needs, which provides a sense of control and comfort. For example, patients can choose between passive and active relaxation, expressive drawing, anger-releasing "whack-a-mole", or more tactile puzzle games.

The Behavioral Health Experience solution equips staff with new tools to manage patients without physical restraint or sedation. Calmer patients mean fewer violent or aggressive incidents towards staff. Staff can communicate with their patients in new ways and learn about their preferences by engaging with patients through the room technology. Staff are also able to control the room environment from outside the room itself. This is important for staff safety and visibility, and provides staff with the opportunity to release new functionalities of the system as the patient's condition improves.

Aesthetics

The technology is unobtrusive and break-proof to meet the stringent safety requirements of behavioral health rooms, with flush-mount installation and secure, tamper-proof enclosures. Projected imagery 'paints' over the ceiling and walls. The technology empowers patients with safe autonomy, where they can tune their own immersive colored lighting and soundscapes to reflect their mood. They can passively or actively engage with tailored, interactive content. At the flip of a switch, the room can convert back to a typical ED exam room with standard lighting when medically necessary.

Business Impact

Behavioral Health patients are a key factor in bottlenecking flow in the Emergency Department, as evidenced by lengthy stays frequently surpassing 24-48 hours. By supporting rapid de-escalation, the use of sedation and restraint can be reduced, resulting in shorter lengths of stay. Staff who build trust with patients may be able to diagnose and introduce appropriate therapy sooner. Combined, these factors can lead to improved ED throughput, reduced ED crowding, and allow the hospital to care for more patients.

Additionally, a reduction in aggressive and violent incidents may help conserve limited ED support resources such as security officers and safety attendants. Decreasing pressure on staff could improve staff morale and reduce staff burnout and turnover. Clinical staff report feeling safer and better equipped to connect with their patients.

Benefit to Society

"Within two hours we were able to take off her restraints and by that evening she was able to be discharged home. It is a story I will never forget." – ED Director, speaking about a repeat patient who was moved to a Behavioral Health Experience pilot room after experiencing a violent and destructive outburst and inability to de-escalate in a typical exam room

"It doesn't matter what type of patient you are, it's much more inclusive for both the patient and safety assistant. It allows me to build a trust relationship with them, keep their mind off the reasons they are here." – ED Team Lead, speaking about the ability to connect with patients using the room technology.