Emergency departments have become the safety net for America's emergency behavioral health patients. Between 2006 and 2014, behavioral health ED visits increased by nearly 57 percent for children and 41 percent for adults, according to AHRQ. This trend continues to grow and is having significant financial and operational effects on ED throughput.
At Becker's Hospital Review's 10th Annual Meeting, multispecialty physician partnership Vituity hosted a panel discussion focused on how healthcare organizations can address the behavioral health crisis facing emergency departments. Sumter Armstrong, Vice President at Vituity, moderated a discussion with health care leaders about potential solutions.
Aligning ED teams to address patient needs
The ED has become the front line for behavioral healthcare. "These individuals come at their greatest time of need. Our main obligation is providing timely care. Too often, behavioral health patients are triaged and then relegated to obscure areas of the ED," said Matthew Stilson, MD, Vituity's Executive Vice President of Emergency Medicine.
The most successful emergency departments have implemented interdisciplinary performance improvement teams with executive sponsorship. These teams include nursing leaders, physician leaders and personnel from patient access, social work, behavioral health and more.
Imamu Tomlinson, MD, Vituity's Chief Executive Officer, explained that “with the treatment of many conditions, such as behavioral healthcare, you need to get the right care to the patient as soon as possible. Aligning teams and holding them accountable with established performance metrics creates an expectation of care improvement and coordination. Cultural and clinical expectations from hospital leadership are also crucial, so all department stakeholders prioritize these types of initiatives.”
Viewing behavioral health as a strategic imperative, not a burden
AMITA Health views behavioral health as a strategic opportunity for their 19 health system locations in the Chicago metro area. Acute behavioral health services are available in 12 of its hospitals. For behavioral health patients, AMITA focuses on "keepage."
"We want to ensure our behavioral health patients receive the care they need within our health system," said Christopher Novak, AMITA Health Behavioral Medicine's Vice President, and COO.
AMITA has invested in a centralized logistics center, which gives crisis workers access to all inpatient behavioral health beds with one phone call. "Our hospitals used to operate in silos, so crisis workers had to call each facility independently. Today we can find placement for patients usually in under one hour," Mr. Novak noted. This helps get patients to the ideal location to receive the right care with the right professionals.
Engaging patients earlier and in new ways
To succeed with population health models, providers must overcome stigmas related to behavioral health patients. Successful treatments depend on earlier engagement with individuals who suffer from mental health problems and substance abuse issues. Technologies such as telepsychiatry, screening tools, and smartphone apps can help.
"Smartphone apps will be very helpful because many chronically mentally ill patients lack insight into their illness," said Gregory Teas, MD, AMITA Health Behavioral Medicine's Chief of Psychiatry. "We need technological ways to connect with patients to remind them to take their medications and to access services. We must develop partnerships with them from the moment they leave the hospital."
Vituity’s Empath model is an example of an integrated approach, which provides clinical services and physician leadership. Designed by Vituity physicians on the front lines of emergency medicine and acute psychiatry practices, Empath brings together front-line physicians and clinical support staff with existing ED teams to optimize workflows and increase staff engagement.
This transformative approach includes a formalized educational program covering agitation and de-escalation best practices, the latest advances in medication management, as well as access to behavioral health clinicians and resources such as telepsychiatry and hospital-based outpatient units that provide a calm, quiet, comfortable setting with immediate access to a psychiatrist to help de-escalate and treat patients in acute distress.
Dr. Stilson stresses that “education for front line providers is essential to accurately identify conditions requiring fast access to specialists. For behavioral health emergencies, a timely assessment and interface with acute psychiatrists put patients on the road to recovery quicker and leads to better outcomes.”
When organizations think about dedicating resources to behavioral health, the return on investment is always a major consideration. "Financial returns are important, but return on investment is also about quality," said Mr. Novak.
Improving care for behavioral health patients will not only heal individuals but will help diminish the harmful stigma all too prevalent today, and result in more compassionate care for all patients.
As a physician-led and -owned, multispecialty partnership, Vituity has driven positive change in the business and practice of healthcare for nearly 50 years. Our more than 3,500 doctors and clinicians provide compassionate, integrated acute care nationwide, serving over 6.4 million patients annually. Visit Vituity.com to learn more.
This article originally appeared in Becker's Hospital Review.