Caring for Psychiatric Patients in the Emergency Department

Emergency Departments across the country see an overwhelming number of mental health cases and due to the complexities of the healthcare system in this country, finding solutions for psychiatric holds and evaluations is even more of a challenge than ever before.

According to the American College of Emergency Physicians, “Over the past 40 years, services for psychiatric patients have become increasingly deinstitutionalized, shifting away from inpatient facilities. As a result, inpatient beds have dwindled to less than 50,000 nationwide, forcing patients to seek other avenues for treatment, including outpatient facilities, outpatient medical management groups, and community resources. Unfortunately, those resources have also become increasingly constrained by widespread budget cuts, leaving patients with the health care system’s last remaining safety net—the emergency department (ED).”

Telepsychiatry

Because of the sensitivity of dealing with behavioral health consumers, hospital systems are working through solutions to streamline psychiatric evaluations. Hospitals nationwide are transitioning to tele-psych services to help reduce the wait times for routine evaluations.

Telepsychiatry is the application of telemedicine to the specialty field of psychiatry. The term typically describes the delivery of psychiatric assessment and care through telecommunications technology, usually videoconferencing.

Depending on the facility and patient community, utilizing the tele-psych services can dramatically reduce the number of psychiatric holds in the ED. For hospitals with little behavioral health resources, evaluations could take days to complete.

Reducing LOS  with Telepsychiatry

Tele-psych allows patients to have a consult within 12-24 hours which provides recommendations faster so staff can release patients with the security of a proper evaluation. Even when facilities see approximately the same number of psychiatric patients, the LOS is reduced, and more patients go home instead of to another facility. A reduced length of stay saves both time and staffing resources.

Additional Options

Most facilities have access to a version of tele-psych, however, with these resources in high demand, it is not always the most beneficial option for care. Some systems are working on internal processes to develop more consistency in the care of psych patients.

Hospitals are using in-house Behavioral Health team members to streamline processes. One of the most important factors is consistency with staffing. Having the same nurses care for behavioral health patients is a key component to efficiencies within the department. If a nurse is – a.) not comfortable caring for the complexities of psychiatric patients, or b.) is not properly trained in the care of mental health consumers, and takes an assignment in the behavioral health area, workflow can be negatively impacted. In addition, maintaining space that separates pediatric patients and adult patients is critical.

Working through all the complexities of caring for mental health patients in this country is a difficult task, but with advanced processes and support from administration, improvements to LOS and patient experience can be achieved.