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Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion
Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion
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With 6 percent of all emergency room visits related to mental health issues and wait times for these patients ranging from eight to 24 hours, a dedicated psychiatric ER would appear to be the ideal solution. But as two emergency department veterans relate in Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion, backup plans are sometimes necessary to manage the flow of behavioral health patients in the emergency room.

In this 35-page special report, Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center, part of Wishard Health Services in Indiana, describes how Midtown's dedicated seven-bed psychiatric ER initially was sufficient to handle patients presenting with mental health issues. But when regional developments caused patient demand to exceed the unit's capacity, further triage strategies were required.

Szempruch explains how the community mental health center's system-wide daily conference call helps to balance work and patient flow across 23 programs, encourages creative problem-solving and dramatically reduces staff time spent on diversion of psychiatric ER patients to other facilities from more than a week each month to just over a day.

Like Midtown, East Jefferson General Hospital in Louisiana had plans for a separate psychiatric ED. But when the ROI analysis for the non-profit community hospital's separate facility didn't hold up, the multidisciplinary team at the state's first magnet hospital went back to the drawing board. Plan B was the placement of a psychiatric nurse in Jefferson's emergency department. Joe Eppling, assistant vice president of post acute and behavioral health services at East Jefferson, describes the objectives of the pilot program, its impact on hospital admits, discharges and resource allocation, and its effect on ED staff satisfaction and morale.

East Jefferson was one of only three facilities that remained open during and after Hurricane Katrina, and Eppling assesses the impact of the post-Katrina environment on inpatient bed availability, ER patient volumes and the extent of the mental health crisis among the region's uninsured population.

In addition, these two emergency room veterans answer a host of questions on the topic and provide additional details on:

  • Identifying barriers to care of psychiatric patients;
  • Reducing time spent on diversion of mental health patients;
  • Improving care transitions of psychiatric patients requiring inpatient admission;
  • Evaluating the financial case for a dedicated psychiatric ER;
  • Reducing inappropriate psychiatric admissions through the ER;
  • Improving satisfaction of ER staff;
  • Adhering to EMTALA regulations regarding the handling of psychiatric patients;
  • Assuring that the uninsured receive equal access to medical and mental health resources;
  • Using medical homes and retail clinics as alternative non-emergency resources for mental health issues;
  • Establishing linkages with community behavioral health providers;
  • Handling high users of ER services, a.k.a. "frequent flyers";
  • Incentivizing PCPs and hospitals for proper ER utilization;
and much more.

Table of Contents

  • Wishard Health Services: A Brief Overview
    • Providing Adequate Care to both Medical and Mental Patients
    • Benefits and Pitfalls of the Psychiatric ED
    • Implementation of a Daily Conference Call
    • Outcomes of the Daily Conference Call
    • Ongoing Avoidance of Diversion
  • Services and Challenges of East Jefferson General Hospital
    • EMTALA Regulations
    • Brainstorming a Solution for ED Diversion
    • Exploring a Psychiatric Emergency Department
    • Integration of a Psychiatric ED Nurse
    • Tremendous Success with the Psychiatric Nurse
    • Moving Forward after Hurricane Katrina
  • Q&A: Ask the Experts
    • Reimbursement for Psychiatric ED Service
    • Evening and Weekend Discharge Strategies
    • Developing Patient Crisis Plans
    • Mobile Crisis Teams
    • Working with Health Plans to Promote Appropriate ED Use
    • Incentives for Primary Care Physician Usage
    • The Role of the Social Worker in the ED
    • Triage Process for Psychiatric Patients in the Medical ED
    • Improving Patient Satisfaction in the ED
    • Reducing ED “Frequent Fliers”
    • Short-term Emergency Housing
    • Utilizing the Bed Huddle
    • Medical Homes
    • Retail and Convenient Care Clinics
    • Screening Tools
    • Challenges of Psychological Triage
    • Decrease of Substance Abuse as a Primary Diagnosis
    • Identifying Mental Health “Frequent Fliers” to the ED
    • Implementing and Enforcing EMTALA Regulations
    • Ideal ED Waiting Times
    • Education on Appropriate ED Usage
    • The Challenge of Decreasing Community Resources
  • Glossary
  • For More Information
  • About the Presenters
Publication Date: November 2008
Number of Pages: 35
ISBN 10: 1-934647-58-6 (Print version); 1-934647-59-4 (PDF version)
ISBN 13: 978-1-934647-58-5 (Print version); 978-1-934647-59-2 (PDF version)
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