BOARDING SOLUTIONS INCREASE PROFITS BY ENDING ER GRIDLOCK © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS Emergency Medicine Summit 5/4/2011
Mental Health Boarding in the ED “PATIENT OVERBOARD!” Damon Kuehl MD, FACEP Carilion Clinic Department of Emergency Medicine VTC School of Medicine © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS
The Problem…
7 Steps to Solving MH Boarding 1 Quantify the problem 2 Improve psychiatric care in the ED 3 Make existing capacity more efficient 4 Collaboration with community agencies 5 Law enforcement collaboration 6 Community crisis services investment 7 Continuity of care Vidhya Alakeson, Nalini Pande and Michael Ludwig A Plan To Reduce Emergency Room 'Boarding' Of Psychiatric Patients Health Affairs, 29, no.9 (2010):
Improvement…
(C) COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS ED Mental Health Patients are Complicated…
Improving Front End All mental health patients = Level 1 triage Standardized patient intake Creation of dedicated ED Mental Health Unit Triage process changes and direct to ED Mental Health Unit Law Enforcement/Magistrate-DIP Program Care plans for unique patients
Throughput Standard order sets and ED zone placement Dedicated ED Psych Nursing Staff Additional 1 fte RN, 1 fte med tech for ED psych unit Psych RN coordinators (Connect Team)
Improving Care in the ED throughput continued… Parallel evaluations (med clearance and Connect team) ED Physician rounder on boarders (2hrs/day) Chronic disease management ECO and placement concurrently Transportation protocols (EMS and Law Enforcement)
Back Door “One Call” for all Mental Health Patients Expanded weekend bed capacity 1 to 1 communication with ED physician and Psychiatric team County/City Mental Health Coordination with Connect Team Automatic Psychiatry Consult for ED >24 hrs Direct Facility Protocol Placement for Unique Patients
QUESTIONS? © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS
THANK YOU! © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS