By Terrey L. Hatcher, Editorial Group Manager, Relias Media
It’s no secret that emergency departments are struggling with how to handle psychiatric patients in crisis when beds are unavailable at inpatient facilities. Many EDs are not equipped to treat acute psychiatric complaints, yet they can’t release involuntary patients if appropriate care is not immediately available. So begins a waiting game.
Being on hold in the ED can cause frustration for behavioral health patients, exacerbate symptoms, and put the health and safety of patients and emergency providers at risk.
At the same time, others who need emergency medical treatment might be kept waiting because the ED bed is taken by someone awaiting psychiatric treatment elsewhere.
In the latest Rounds With Relias podcast, Scott Zeller, MD, suggests alternate approaches. Making patients wait for a bed at an inpatient facility—called “boarding”—is not always best practice. He advocates lining up multiple options, including telepsychiatry, comfortable units for short-term care of less than 24 hours, and inpatient treatment.
As vice president for acute psychiatry at Vituity, a company that supports some of those services, Zeller suggests that emergency providers should be ready to treat psychiatric patients in the same way they treat other medical emergencies. In other words, “let’s assess the patients, and let’s initiate treatment where indicated. And see how people respond to treatment before making a decision that they need to be hospitalized,” he says. “If we do that, we are really going to change the dynamic in incredible ways.”
Zeller is participating in an initiative called ED & UP, led by the Boston-based Institute for Healthcare Improvement, in partnership with Well Being Trust. The initiative has brought together nine hospitals to work with expert faculty and test new ideas for equipping EDs to better respond to patients with behavioral health needs.