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Regional Psychiatric Emergency Services: Good for Psychiatric Patients and EDs

October 31, 2013

Regional Psychiatric Emergency Services: Good for Psychiatric Patients and EDs

  1. Cheryl Lynn Horton, MD

Average ED boarding time was less than 2 hours, and 75% of patients were discharged directly from the psychiatric stabilization unit.

  1. Cheryl Lynn Horton, MD

In Alameda County, California, a regional psychiatric emergency services (PES) facility accepts all patients on psychiatric holds. Patients receive intensive psychiatric treatment for up to 24 hours, with the goal of rapid psychiatric stabilization to avoid inpatient hospitalizations. To determine the effect of this regional PES facility on emergency department (ED) boarding times and hospitalization rates, 5 community hospitals tracked all ED patients on involuntary mental health holds during 1 month.

Average ED boarding time from medical clearance to ED discharge was 108 minutes. Of the 144 patients referred to the PES facility, 75% were stabilized within 24 hours and discharged directly from the facility, with only 25% of patients requiring inpatient hospitalization.

Comment

Recent U.S. studies have reported average boarding times of more than 10 hours and hospitalization rates between 52% and 71% for psychiatric patients. With emergency department visits for mental health disorders on the rise, the lack of psychiatric inpatient beds is a significant problem. For systems in which the number of patients requiring emergency psychiatric care far exceeds available inpatient psychiatric beds, creation of a regional psychiatric facility is a feasible solution. The authors suggest that creation of a national billing code for Crisis Stabilization, as California Medicaid has done, would promote formation of emergency psychiatric service units and ultimately save money. Better and less expensive care for psychiatric patients and shorter ED boarding times — let's make this happen.

  • Disclosures for Cheryl Lynn Horton, MD at time of publication Nothing to disclose

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