July 13, 2018
Scott Zeller, MD, Vice President of Acute Psychiatry, Vituity
Robin Henderson, PsyD, Chief Executive, Behavioral Health, Providence Medical Group Oregon and Clinical Liaison, Well Being Trust
Vera Feuer, MD, Director of Pediatric Emergency Psychiatry, Northwell Health
Mara Laderman, MPH, Director for Innovation, Institute for Healthcare Improvement (IHI)
For all that emergency departments (EDs) do to stabilize individuals and save lives, they’ve never been the ideal place for patients whose crises are related to behavioral health. EDs are designed to address the most urgent, sometimes life-threatening problems, and then discharge or transfer patients to the appropriate next level of care. If a psychiatric or addiction-related admission is needed, however, there may not be any beds. This often leads to boarding patients in the ED or adjacent hallways for hours, sometimes days.
In the US, many blame an underfunded mental health system for the shortage of inpatient beds and an inadequate supply of outpatient services that might help patients avoid going to the hospital altogether. Emergency department staff aren't any happier with the status quo. They have begun to look at how EDs might improve the overall care experience for behavioral health patients and contribute to continuity of care.
Promising new practices are being tested in nine hospitals participating in Integrating Behavioral Health in the Emergency Department and Upstream, an initiative led by IHI in partnership with Well Being Trust. Improvements these hospital EDs are testing include creating new lines of communication and care coordination, including post-discharge follow-up, with community-based services; standardizing and streamlining processes from intake to discharge for a range of mental health and substance abuse issues; working with both patients and their family members on self-management skills; and educating ED staff on behaviors consistent with a trauma-informed and empathetic culture.
We dicsussed these tests and innovations on the July 12 episode of WIHI: How to Build a Better Behavioral Health in the Emergency Department