C.E.R.E.B.R.O : Central EPIC Requisition of Emotional & Behavioral Responses Organizer

Nature and scope of the project: Patients admitted into the intensive care unit (ICU) anticipate critical medical/surgical issues to be addressed. However, it may not be the primary focus of ICU hospitalization; patients' mental health needs must be addressed to be successfully discharged from the ICU and/or the hospital. Evidence-based studies have shown interventions and tools to assist with the physical aspects of Post ICU Care Syndrome (PICS). PICS collectively have produced a prevalence of complications for the patients and families after stays in the ICU. Cognitive impairments occur in 30-80% of those leaving the ICU. Concerns of anxiety, depression, and PTSD account for 8-57% of the cases, where the effects can last for years afterward. The average length of stay increases by 40% due to psychological stress. Psychiatry is consulted only in extreme cases where a patient has committed acts of suicide or is currently suicidal, or the clinical judgment of the ICU staff requires a psychiatric provider to assist in the care planning. Synthesis and analysis of literature: Overall, 2164 articles were found in three databases. Of the articles, 18 were found to describe psychiatric providers consulted in the ICU. The six themes from these articles included: an embedded behavioral health provider/team, utilizing the EHR, taking a proactive approach, past psychiatric/substance-use history, past trauma history, and psychotropic prescriptions (future, present or past). Reviewing with the team, the embedded team member(s) have the financial barrier, whereas the remaining five themes utilize the existing EHR. Project implementation: The project will utilize the existing EHR with a revised triggering methodology to initiate consultations in the ICU. In addition, a new dashboard called C.E.R.E.B.R.O. will provide healthcare providers with snapshots to encourage consultations that are not automatically triggered, including EHR themes. Outcomes: The project evaluates three aspects of a dashboard in the ICU: increased psychiatric consultations, improved healthcare provider satisfaction, and decreased average LOS for patients. In 2022, 33.53% of patients in the ICU had a DSM-5 diagnosis. There were 18 consults counting for 0.2% of the total patients. The leading diagnosis groups were anxiety/stress disorders, mood, and substance use. For admitted patients, 36.8% had a DSM-5 diagnosis, with the leading diagnosis groups being anxiety/stress, mood, substance use, and neurocognitive disorders. Recommendations: The dashboard C.E.R.E.B.R.O. will guide practice allowing for a more proactive approach to care. It will require extensive time with the Information & Technology Services to implement. In the future, psychiatric services will become an embedded member of the ICU. Further work and studies with C.E.R.E.B.R.O. could increase the rate of EHR triggers and process automation.