Boarding Psych Patients in the ED is a Terrible Idea. Here's an Alternative.

There are countless stories about psychiatric patients waiting for hours or even days in emergency rooms. I've shared links to a few of those stories at the end of this piece.

Fellow human beings are experiencing life's lowest point, and they are often told to hurry up and wait. Most emergency department (ED) staff are trained to handle visible medical trauma, but not excruciatingly painful internal anguish.

"Ugh. He's back."

"Why do we have to take care of these people?"

"You'll have to wait. Please get back in your room."

These are some of the comments psychiatric patients might hear in an ED, compounding the stigma of mental illness and adding to feelings of shame and inadequacy. Most ED staff don't say these things, but the few that do utter these phrases can cause plenty of damage with their words.

The Right Care at the Right Time

Moreover, most ED docs don't get enough training to adequately handle or even triage psychiatric emergencies, including psychotic agitation, suicidal ideation, or panic attacks. That's why they deserve the option of quickly consulting well-trained psychiatric providers or mental health professionals. Even better, why not move patients out of the ED as soon as medically indicated and start treating psychiatric symptoms with the right clinical team in the right clinical environment?

Last year, we opened our psychiatric stabilization unit (PSU), an emergency observation unit of sorts that was modeled after Dr. Scott Zeller's emPATH Unit. Instead of ED bays or psychiatric beds, the PSU is made up of two large rooms, each with large recliners, accommodating up to 12 patients in the adult milieu and up to 5 patients in the youth milieu. The PSU is staffed by a multidisciplinary team that includes social workers, psychiatric nurses, mental health workers, and psychiatric providers.

On an average day, our ED serves well over a dozen patients who are experiencing a psychiatric crisis, or about 8-10% of all daily ED patient encounters.

Low Hanging Fruit

In a matter of months, we were able to reduce the average ED length of stay for psychiatric patients by more than 50% to about 4 hours, and the average number of patients being boarded in the ED for over 24 hours every month dropped from 14 to 2. These are just some of the early wins we can report and I hope to share more data as our first year in the PSU draws to a close.

A New Standard of Care?

It's hard to understand why every hospital with a team of psychiatric providers doesn't open a service modeled after the emPATH Unit. Some organizations have even opened such a unit and supported it primarily with telepsychiatry services.

Dr. Zeller has been talking about this model for years, and he is featured in the CNN online article published this week. Last year, Yale published an article in which it documented the benefits of a similar psychiatric observation unit.

I'm glad this new level of psychiatric care is finally gaining national attention. It has the potential to improve access to and the quality of emergent psychiatric care, while helping systems of care make better use of existing inpatient psychiatric resources.