Patients with a medical and psychiatric comorbidity have significant complexity that is often overlooked. Meeting these patients’ behavioral health needs is highly variable, often inadequate and at times, unsafe. Recognizing these opportunities led to the creation of a 16-bed, Complexity Intervention Unit (CIU). The innovative environmental design of the CIU puts safety at the forefront by incorporating ligature resistant plumbing, doors, fixtures and other features. Room amenities minimize unnecessary equipment while containing what is needed to effectively provide care. Video monitoring is built into patient rooms and common areas. The nurses’ station has a clear line of sight into the entire unit, and a therapeutic milieu includes a day room for activities and a group therapy room. 

The care team within the CIU consists of physicians with dual board certifications in internal medicine and psychiatry, advanced practice registered nurses, social workers, nurse case managers and medical-surgical nurses. The clinical nurses in the CIU were prepared for this new population by participating in an educational curriculum designed to improve their knowledge of behavioral health conditions, advanced de-escalation and trauma-informed care. Additionally, two highly trained social workers and one case manager focus on enhanced care coordination and address complex discharge needs. Security is also an essential part of the CIU; the care team is committed to rounding in the unit frequently to maintain safety for all. 

The CIU is a creative solution to care for active medical and psychiatric illnesses concurrently using a care delivery model specific for their needs. The CIU uses best practices and standardization of care through specialized care protocols, pathways and order sets designed to improve outcomes. This leads to a reduction in staff and patient injuries, decreased utilization of patient safety attendants which reduces staffing costs, decreased readmissions and a shorter length of stay. The CIU is a new and innovative way to meet the health network’s goal of providing the right care to the right patient at the right time.