Many psychiatric patientswait 24 hours to be seen
Many psychiatric patientswait 24 hours to be seen
Death, survey results show seriousness of problem
The recent death of a 49-year-old woman in the psychiatric ED of Kings County Hospital in Brooklyn, NY, after more than a 24-hour wait, dramatically illustrates the challenge of EDs trying to serve these patients. This challenge was further underscored by the findings of a survey conducted by the American College of Emergency Physicians (ACEP), which found that due to a lack of psychiatric beds, many of these patients, including children, can experience similar waits.
Nearly 80% of the 328 ED directors responding to the survey said their hospital "boards" psychiatric patients in the ED. Thirty percent said their hospitals typically board these patients eight to 24 hours; and more than 25% said their hospitals board children with psychiatric illnesses for that long.
The incident in Brooklyn was not a fluke, warns David Mendelson, MD, FACEP, the principal author of the survey. "It's just a matter of time until it happens again," predicts Mendelson, who is a member of the ACEP Emergency Medicine Practice Committee and chair of its subcommittee on psychiatric and substance abuse; vice president of medical affairs for Dallas-based EmCare, a contract ED staffing company; and a practicing emergency physician.
This is the No. 1 issue for the Minnesota ACEP, and it has been the top priority for years, says Steve Sterner, MD, chief clinical officer and an emergency physician at Hennepin County Medical Center in Minneapolis. Sterner is chair of a joint ACEP/Minnesota Medical Association task force evaluating psychiatric bed availability and the boarding of psychiatric patients.
The ED sees a large number of these patients because in many states, mental health is "carved out" of insurance products, he says. Thus, the ED becomes the "safety net" for mental health patients, Sterner adds. "Unstable mental health patients also tend to have more physical health problems than the general population," he notes. "They have an increased incidence of other chronic diseases and substance abuse, which also end up being treated in the ED."
Those patients need to be treated in a psychiatric ED, or at the very least, in a separate area of the ED designed and staffed for such care, Sterner says. "This is better for the patients because the ED environment is just not the perfect environment for an unstable patient with mental health problems," he says. "They are usually apprehensive, often paranoid, and the constant distractions of a busy ED are an unsettling, stressful environment for them."
Mendelson agrees. "If you have such an area, then you have quiet, efficient space away from the regular hustle and bustle of the ED where these patients, who are absolutely at the end of their ropes, can be in a quiet atmosphere."
The recent death of a 49-year-old woman in the psychiatric ED of Kings County Hospital in Brooklyn, NY, after more than a 24-hour wait, dramatically illustrates the challenge of EDs trying to serve these patients.Subscribe Now for Access
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