Lukose hired a family nurse practitioner with a background in psychiatric nursing as the psychiatric liaison. The NP worked eight-hour shifts, Monday through Friday. She rounded on behavioral health patients in the ED, completed the psychiatric evaluation, initiated appropriate interventions, and coordinated discharge planning.
"The interesting thing that we found was many of them did not need to be in an inpatient psych unit," says Lukose. "Because the ED physicians were not comfortable, they would keep them" until the patients could be transferred to a psych unit.
The NP also facilitated a 30-day medication supply program for underinsured patients and established a "bridge" program for patients who needed temporary support until they connected with a behavioral health follow-up provider.
"If they get discharged from the ED, they don't always get an appointment for follow-up right away. It might take a month or three weeks," Lukose says. "She provided three follow-up visits while [a patient] was waiting for the post-discharge follow-up with the mental health provider. They could walk into her small program, which is a room in the ED."
Location, Location, Location
Creating a dedicated space in the ED for behavioral health patients may sound costly, but Lukose says it wasn't not the project highest ticket item. The largest expense in the entire project was hiring the NP.
"Doing the facility enhancement is not a costly program," she says. "We weren't buying equipment. We just removed items to make the room simple."
Working with the ED director, they were able to identify a section of the ED where five beds could be dedicated to behavioral health patients. The crisis department, which had previously been located outside the ED, was moved inside the department to help improve collaboration.
"There was a big disconnect between the crisis staff and the ED staff so we moved their office to this particular area so they are available constantly," she says.
Clustering the behavioral health beds in one area also facilitated a decrease in sitter use.
"We had them in the general ED, but here and there, we had to provide a sitter for each patient," Lukose says. "In reality, they don't always need one-to-one care. Because we have this one separate area, you can have one sitter for three patients."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.