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'Triage center' takes pressure off EDs
Referral facility for behavioral health patients
The creation of a new area to quickly assess homeless and uninsured individuals, many requiring behavioral health services, has helped ease pressure on EDs in the Lee Memorial Health System in Fort Myers, FL. It has also earned the system a 2010 AHA NOVA Award for "Community-Based Alternatives to the Emergency Room."
In the 18 months since the program was established, 705 duplicated (multiple visits) and 474 unduplicated individuals were referred to the Lee County Behavioral Triage Center, the formal name of the new shelter. One-third was from hospitals, and two-thirds from law enforcement. Of those patients, 30% were referred to another emergency shelter or supported housing, and more than 15% entered inpatient substance abuse treatment.
"This absolutely frees up ED beds and internal hospital beds, since you do not have someone laying on an ER stretcher for several hours," notes Jennifer Higgins, RN, MSN, CEN, director of emergency and transport services at Lee Memorial Hospital.
In addition, Higgins says, it has been a morale booster for the staff. "They're just really happy there's an alternative for these patients, instead of them being put back out on the street," she explains. "Sometimes in the past there was a mission to refer them to if we got lucky and then we knew they'd be safe, but otherwise when they were discharged in the past they'd either walk out or have to be jailed if they had done something in the community." Sometimes, she adds, these patients would end up being admitted "for no other reason than they had no place to go."
A community effort
The shelter got its impetus in 2007, when the Lee Memorial Health System board of directors convened 38 community leaders representing business, public education, higher education, government, non-profit organizations, clergy, and health care professionals in all sectors of the system's primary service area of Lee County. The goal was to create the Community Health Vision for 2017 by making specific recommendations to improve the health status of residents and the health care delivery system.
There were 11 partner agencies involved: the Lee County Board of County Commissioners, Lee Memorial Health System, Lee Mental Health Center, Southwest Florida Addiction Services, The Salvation Army, United Way of Lee County, National Alliance of Mental Illness of Lee County, Fort Myers Police Department, Cape Coral Police Department, Lee County Sheriff's Office, and Florida Department of Children and Families, Substance Abuse and Mental Health Program.
Chief Administrative Officer Lisa Sgarlata, RN, MSN, CEN, says, "Together we applied for and received a $3 million grant [from the state] for three years."
A small area of space was donated by the local Ruth Cooper Center (a part of Lee Mental Health), she says, and The Salvation Army agreed to run the shelter and provide a case manager. "We provide part of the food cost and staffing from a nursing perspective," says Sgarlata. As former director of emergency services, she was well positioned to represent the ED's interests and contribute input into the handling of the patients.
When patients are referred to the shelter, by the police or the ED, they are seen by a contracted nurse with an ED background. "We make sure they do a minimal screening, using inclusionary and exclusionary criteria," says Sgarlata, who notes these screenings are not subject to EMTALA. "If they need to be seen by an ED, we call the EMS through 911," she adds.
ED managers interested in creating a similar program in their communities should be sure to "get everyone at the table at the same time," says Sgarlata. "There needs to be a willingness for everyone in the community who touches that patient to be committed."
Higgins says, "They all have something to benefit, and they all have the patient's best interests in mind. We knew there were other alternatives, and we owed it to our community to find a better solution."
For more information on creating a facility for behavioral health care patients, contact: