Date of Publication


Project Team

Marcia Bosek, DNSc, RN; Todd Hill, LICSW


Purpose: The Community Mental Health Act (1963) created crisis stabilization units to lessen burdens of emergency departments addressing psychiatric crises. Crisis stabilization units – including the project site – evaluate treatment efficacy via assessments including the Level of Care Utilization System (LOCUS). The LOCUS is totaled into a composite score, expected to decrease at treatment completion. The project site has not consistently seen LOCUS scores decrease at completion. The project’s purpose was to improve use of a clinical assessment tool to reflect treatment and progress for patients utilizing crisis stabilization programs. A secondary aim was to increase incidence (75%) of composite LOCUS score change (decrease from admission to discharge).

Methods: A Failure Mode and Effects Analysis focusing on LOCUS completion identified staff knowledge gaps. An evidence-based QI project was implemented. Composite admission and discharge LOCUS scores for clients at the project site were collected by staff and compared pre- and post-intervention.

Results: Thirteen of 23 staffers (57%) attended intervention. Of pre-intervention (n=35) composite scores, 66% (n=23). decreased from admission to discharge. Of post-intervention (n=11) composite scores, 46% (n=5) decreased.

Conclusions: The 75% incidence aim was not met. Multiple factors may have impacted post-intervention findings. Staff who completed LOCUS post-intervention were not identified; this limits the ability to evaluate the intervention’s impact. Lack of uniformity in data collection impacted intervention fidelity. Replication of this QI project with all staff is appropriate. Future QI projects could assess other aspects of LOCUS completion process (clinical interview, EHR review). Research is needed to assess reliability of LOCUS in crisis stabilization settings.

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