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Strategies for ED Psych Patients

Jacqueline Fellows, for HealthLeaders Media, May 13, 2014
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The purpose of the collaborative was to find psychiatric inpatient beds for the patients who were showing up in the hospitals' EDs no matter where the patient went for care initially.

"The hospitals agreed early on that the discussion was about the patients," says Klingler. "It was about getting the patient in the right bed at the right time, and we were able to kind of put aside all of the competitive stuff and really focus on getting a patient into a bed as quickly as we could."

After nearly a year of talks, the three health systems developed a simple protocol: The patient who has been waiting the longest for a psychiatric inpatient bed gets the first one available, no matter where it is located. If a patient is in a Mount Carmel ED, and an inpatient bed opens up at an OhioHealth hospital, the patient goes to OhioHealth.

"Right now the bed board is all about getting a patient into the bed quickly," says Klinger, who is in charge of managing the online bed board hospitals log in to daily to input and monitor the county's psychiatric patient load in the EDs.

The database has provided relief. In May 2009, there were 400 psychiatric patients in Franklin County EDs, when wait times for a bed could number up to six days. A year later in May 2010, the wait time had fallen to 30 hours, and by October 2013, the average length of stay for a psychiatric patient needing an inpatient bed was down to 19 hours despite an increase the number of psychiatric patients seeking care in Franklin County EDs.

Participation among providers in the Franklin County Mental Health Collaborative has grown, too. When it began, only three hospital systems participated; now, Klingler says, every organization with psychiatric inpatient beds is a using the bed board.

"Before we started this process, the hospitals were calling each other saying, 'Hey I've got so many patients in my ED; do you have any beds open?' And the other hospital would say, 'No, I don't have any beds open,' when maybe they did have a couple of beds open but they kept them for themselves," he says. "Now, it's very transparent, and they're more trusting."

Success key No. 2: Regional psychiatric emergency service

Coordinating the emergency care of psychiatric patients among hospitals has also caught on in California's Alameda County, an 800-square-mile expanse that includes Berkeley, Oakland, and Fremont.

Scott Zeller, MD, chief of psychiatric emergency services for Alameda Health System, an integrated public health system based in the city of Alameda, says that routing psychiatric patients to a dedicated regional facility reduces the length of stay in the ED, and helps stabilize patients who are in a mental health crisis.

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