Psychiatric Care as an Answer to Improve ED Patient Flow

As more emergency departments are being flooded with psychiatric patients who have fewer and fewer options for care, emergency department (ED) wait times are increasing from the pressure that this influx is putting on bed availability. HealthOne in Denver has taken a bold step to improve ED throughput by deciding to open a psychiatric ward, even if it loses money.

At a time when many hospitals across the country are closing their psychiatric units to cut costs, Denver’s HealthOne has decided to open a 40-bed psychiatric ward that the facility believes will help manage the influx of psychiatric patients seeking treatment in its ED. It is the first psychiatric ward to open in Colorado in years.

HealthOne is not alone in trying to cope with a significant increase in psychiatric patients seeking treatment in the ED. EDs nationwide are seeing greater-than-ever numbers of psychiatric patients because state hospitals and institutions have been shut down because of government budget cuts. State legislatures have cut $3.4 billion in mental health services, shutting out roughly 400,000 psychiatric patients who had previously sought help at public mental health facilities during the past three years, according to the National Association of State Mental Health Program Directors (NASMHPD). To compound matters, the number of people seeking treatment for anxiety and depression during the same timeframe has increased, largely as a result of difficult economic times. As a result, the demand for psychiatric care has risen 18 percent.

Treating and bedding such a large patient population is costly and can significantly bog down ED patient flow. In the ED, wait times are in large part a function of how many patients are waiting to be seen compared to the number of ED beds available. Most EDs do not have the capacity to handle the increased patient flow, nor are they equipped with secure holding rooms and quiet spaces for distressed patients. One study reported that wait times for 1,092 psychiatric patients averaged 11.5 hours. Patients who had to be transferred outside a health system waited 15 hours.

The ability to move psychiatric patients to an appropriately staffed and equipped unit will greatly improve HealthOne’s ability to process these patients through their ED. HealthOne hopes to recoup some of the costs incurred for the psychiatric unit by being able to provide faster, more efficient care in its ED.

The new psychiatric unit will also help fill a much-needed gap in local health care. The state was found to average 11.8 psychiatric beds for every 100,000 residents; the national average is 30, according to the American College of Emergency Physicians.

To learn more about best nursing practices in psychiatric emergencies, look into Mosby’s ENA: Handling Psychiatric Emergencies online course.

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