A Consistent Approach to Complex Patients with Secondary Psychiatric Diagnoses: The Orange Chart Project

Student Author(s)

Marvin Solberg

Faculty Mentor(s)

Susan Dunn, PhD, RN and Jennifer Peterson

Document Type


Event Date



In a large Midwest hospital’s complex medical inpatient unit, patients with secondary psychiatric diagnoses often exhibit intrusive behaviors, disrupting the unit and creating barriers to discharge. Because of such behaviors, the quality of care they receive may not be at its full potential. Little research exists regarding effective interventions for these patients that help reduce their negative behaviors or its detrimental effects on themselves, nursing staff, and other interdisciplinary team members. A protocol for this inpatient unit, titled the “Orange Chart” project, was introduced in November 2013 to improve consistent, team-based management of these patients. The purpose of this retrospective medical record review study is to identify if pilot use of the Orange Chart protocol was associated with an increase in psychiatric consults and a reduction in security consults, hospital length of stay, number of 30-day emergency department visits, and hospital readmissions for patients with secondary psychiatric diagnoses compared to pre-pilot use. Betty Neuman’s Health Care Systems Model provides a theoretical framework for this study because patients are seen as open systems, reacting to stimuli, dictating their outcomes. The expected sample size is 30 patients from the single hospital inpatient unit of this Midwest hospital. Results and conclusions of this study are pending. Expected statistical analysis include independent t-tests using SPSS, with a value, p < 0.05 for all tests. Expected limitations include a small sample size and limited generalizability. Possible future implications include implementation of a consistent approach to behavioral management in this patient population throughout hospital systems.


This research is supported by Spectrum Health.

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