Patients with mental and behavioral health issues rather than physical ailments often cause a bottleneck in hospital emergency rooms for "up to a week or more" because inpatient psychiatric beds are lacking.
That's one of the conclusions from a recent survey of 603 emergency department administrators, 56% of whom said they are often unable to transfer patients in a timely manner, and 30% of whom said they are sometimes unable to do so.
Of the 603 who responded, 29% said the longest board times they are experiencing with mental health patients is 12 hours or less. However, 41% reported seeing board times of up to two days or longer, and 10% said they are seeing board times of up to one week or more.
The survey was distributed to respondents in July and August by the Schumacher Group of Lafayette LA, one of the three largest emergency department management firms in the country. Schumacher says it manages operating and staffing for 180 acute care hospital EDs, with three million ED patients annually.
"The evidence of a widespread breakdown in mental health services is becoming increasingly apparent in the nation's EDs," the Schumacher Group said.
What's more, 60% of ED administrators said long board times for the mentally ill "have compromised quality of care, in some cases for mental health care patients only and in some cases for all patients."
Sandra Schneider, MD, president of the American College of Emergency Physicians, says she is "not at all surprised by these statistics.
"There's an enormous problem in large and small hospitals across the country, with facilities holding psychiatric patients—sometimes 15 or 16—and kept there for days. We've been seeing this problem for decades."
Schneider says that while in the emergency department, "most of the time they are receiving very little if any mental health care. The most they might get is some sedation so they don't act out and disturb other patients. And there's a feeling among individuals that these patients are not sick, when they are some of our sickest, most vulnerable patients."
A big piece of the problem is the acute need for appropriately equipped holding facilities staffed with professionals who specialize in patients with mental illness and patients who have substance abuse issues. And many emergency room patients may also be suicidal, according to a Sentinel Alert issued last month by the Joint Commission.
Schneider says she recently heard of a psychiatric patient who, while boarded in a hospital emergency room waiting for a transfer, "drank hand sanitizer that was on the wall."
Ideally, hospital emergency rooms would have appropriately staffed holding areas for psychiatric patients, or could transfer them to special psychiatric facilities, says Schneider, an emergency physician at Strong Memorial Hospital in Rochester, NY.
Among the survey's other findings:
- Two thirds of ED administrators responding to the survey believe health reform will cause patient volume in their EDs to increase, not decrease, because more newly insured patients will be unable to access primary care and specialty services. About 17% said they thought it would remain the same, and 5% said they thought it would decrease.
- Orthopedic surgeons and neurosurgeons were said to be the specialists in shortest supply for emergency department call, followed by neurologists, cardiologists, general surgeons, otolaryngologists and cardiovascular surgeons.
- While 73% of ED administrators responding to the survey said their hospital had invested in electronic medical records in the ED, 56% said that to date, the investment has not been worth the cost. However, 76% said that eventually, the investment would justify the cost.
Of the 603 ED administrators who responded to this survey, 36% said their hospitals had fewer than 51 beds and 28% said they had 201 beds or greater. Responses came from 47 states, but the largest percentage of respondents, 11%, came from Texas.
Of those responding, 59% said between 11% and 30% of their hospital's ED patients are uninsured.