1. BOARDING SOLUTIONS INCREASE PROFITS BY ENDING ER GRIDLOCK © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS Emergency Medicine Summit 5/4/2011

2. 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

3. The Problem…

4. 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):1637-1642

5. Improvement…

6. (C) COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS ED Mental Health Patients are Complicated…

7. 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

8. 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)

9. 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)

10. 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

13. QUESTIONS? © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS

14. THANK YOU! © COPYRIGHT 2011 VIRGINIA COLLEGE OF EMERGENCY PHYSICIANS