Treating behavioral health patients carries a unique set of challenges for healthcare organizations. 

Often dubbed “invisible illnesses” due to their not-always-obvious symptoms and lack of straightforward diagnoses, mental health disorders are on the rise among patients of all ages. This makes awareness of them—and their associated risks—paramount for provider organizations. 

Kodiak has identified behavioral health as one of the biggest clinical risk areas facing healthcare organizations. Other top clinical risk areas are surgical safety, device disinfection, instrument sterilization, and clinical coding compliance. Read on to find out where behavioral health risks may be hiding in your organization, what types of risks you should be looking for, and how internal audit can help you mitigate them.  

Where do behavioral health risks exist? 

In short, behavioral health risks exist throughout healthcare organizations. Risks can be evident in areas or departments where behavioral health is a primary focus, such as inpatient psychiatric units, designated receiving facilities, intensive outpatient programming, and individual outpatient therapy. 

However, behavioral health risks also can exist in less obvious organizational areas in which behavioral health is not the primary focus. These less-obvious areas include emergency departments, which, notably, are a first point of contact for many behavioral health patients, and inpatient units, including the ICU and medical-surgical floors. When behavioral health patients are treated in these areas, other factors may multiply the risk. Those factors include the staff’s lack of regular exposure to the behavioral health patient population and training gaps related to suicide risk screening, suicide risk prevention, care coordination, and restraint use. In addition, inadequate care of these patients treated in settings where behavioral health is not the primary focus can result in deterioration of the patient’s condition and overall poor quality care. 

What are your risks? 

So, what are the biggest risks for healthcare organizations when it comes to behavioral health? 

• Gaps in suicide risk screening processes, which can lead to inaccurate risk stratification of patients and potential patient harm. 
  
  
• Incomplete guidance on suicide risk precautions, which may result in patient self-harm or patient elopement (when a patient leaves a medical facility unsupervised or unnoticed). For example, organizations might fail to remove ligatures or sharp objects from a patient’s room. 
  
  
• Inadequate patient assessment, care coordination, education, discharge planning, and multidisciplinary treatment planning. This can result in incorrect acuity placement, delayed discharges, and negative impacts on the patient’s long-term treatment success. 
  
  
• Inaccurate or noncompliant coding and documentation. Complete and accurate documentation of a patient’s encounters across the care continuum not only reduces care errors and improves care quality but is crucial for accurate reimbursement. 
  
  
• Noncompliance with standards of care related to behavioral health patient care, which can result in harm to patients and staff and loss of accreditation. 
  
  

How you can mitigate behavioral health risks 

Some steps your healthcare organization can take to mitigate these risks include the following: 

• Educate staff on critical processes related to: 
• Suicide risk screening and precautions, such as removing harmful objects from suicidal patients’ rooms 
• Restraint and seclusion use 
• Care coordination, treatment planning, and discharge planning 
• Patient elopement, including steps to prevent elopement and policies for safely returning patients to the hospital 
• Workplace violence prevention 
  
  
• Provide adequate training at hire and on an ongoing basis, giving staff the skills required to successfully care for behavioral health patients. 
  
  
• Provide oversight of staff documentation and provide live feedback to staff about documentation. Fixing documentation errors immediately can help prevent errors from being made going forward. Behavioral health coding can be challenging, and behavioral health patients oftentimes are seen by multiple clinicians during one encounter. Any efforts to educate providers about thorough documentation and behavioral health codes can go a long way toward improving documentation accuracy and patient care. 
  
  
• Maintain policies and procedures to validate their alignment with evolving standards of care. Regular review of policies and procedures helps ensure the care provided is up to date, accurate, and safe. 
  
  
• Offer regular refreshers in organizational areas where exposure to the behavioral health population is limited. Regular staff huddles, newsletters, or emails are some ways healthcare organizations can help keep behavioral health skills front of mind for staff. 
  
  

Internal audit’s role 

Internal audit plays a critical role in testing the efficacy of your organization’s behavioral health processes. Auditors can conduct: 

• Medical records testing. This includes looking at medical records to make sure documentation is complete and was performed accurately, and that it aligns with the organization’s policies and with accrediting bodies’ requirements. 
  
  
• Training records testing. Auditors can investigate to determine whether staff are receiving necessary training at the required frequencies. 
  
  
• Policies and procedures testing. Auditors conduct this testing to make sure all policies and procedures related to behavioral health align with accreditation standards and Centers for Medicare & Medicaid Services requirements. 
  
  
• On-site observations and interviews. During these visits, internal auditors “have eyes” on the unit to make sure dangers such as ligature risks are mitigated and that staff are aware of what they need to be doing to keep behavioral health patients on the unit safe, including awareness of all organizational policies and protocols. 
  
  

A multidisciplinary approach to auditing behavioral health processes is critical to ensure all staff are on the same page and working in conjunction to give patients the safest, highest quality care. The following staff members should be included in behavioral health risk audits to reinforce their depth and quality: 

• Quality/compliance. Staff in these areas can provide oversight and follow up to see if new procedures or policies implemented based on audit findings have been implemented. 
  
  
• Nurse managers. These front-line staff members have frequent and direct contact with patients and staff and offer critical “on the ground” insights into risk mitigation efforts and whether policies and procedures are being followed. 
  
  
• Nurse educators. In charge of providing education and training to nurses, these critical staff members can adjust that training based on audit findings, ultimately making education more effective. 
  
  
• Subject matter experts. These individuals, whether sourced from inside the organization or through collaboration with third-party partners, can help you identify risks and offer strategies for testing them.
  
   

Cover all your clinical risks 

Clinical audits are an essential part of your healthcare organization’s patient safety efforts. Focusing on minimizing risks, including in vulnerable areas such as behavioral health, will go a long way toward improving the safety and quality of care you provide, enhancing the care experience for your patients and staff, and helping reduce your overall costs. 

At Kodiak, our clinical internal audit experts will work with you to identify your organization’s highest risk areas and recommend strategies and tactics to reduce your risks in those areas. Contact us today to find out how we can elevate your clinical audits and reduce your organization’s risks.