Program illustrates how cooperation among county health leaders, hospitals and physicians leads to better care and outcomes
Facing a 75 percent increase in patients in the Emergency Department (ED) placed on psychiatric holds, Rideout Regional Medical Center and Sutter-Yuba Behavioral Health opted to build a first-of-its-kind collaborative mental health program focused on ensuring patients get prompt quality care, quick referral to, and help from, all available community resources. After just six months, a number of key clinical measurements have been significantly improved, including length of stay, time to discharge and overall improvements to psychiatric care.
Located in Marysville, Calif. and serving Sutter and Yuba counties, the Mental Health Emergency Stabilization Initiative was developed by the hospital’s ED leadership in conjunction with Sutter-Yuba Behavioral Health and Vituity, one of the nation’s largest providers of multi-specialty acute care solutions. Unique features of the program include its emphasis on team-based care in the ED, collaboration with county behavioral health leaders to ensure coordination of resources, and the use of a telepsychiatry platform from CEP America. The telepsychiatry platform helps ensure access to care 24/7 through California-licensed and board-certified psychiatrists with specialized expertise in Emergency Psychiatry resulting in reduced admissions and safer discharges to other community resources.
“The early results from this program are important and exciting for our hospital and community,” said Theresa Hyer, RN, director of Emergency Services for Rideout. “Like many hospitals, we struggled to care for a growing number of mentally ill patients as community resources were closed or consolidated. To find a way to solve such a challenging problem in our community, and then to see such great results shows what can be done when we work together to tackle tough problems.”
Rideout faces many of the issues other hospitals in the nation face: increasing numbers of mentally ill patients presenting to the ED, a shortage of providers, concerns over workplace violence, and rising costs. Hyer estimates soft costs associated with the mental health crisis affecting Rideout’s ED are over $3 million dollars. For example, increasing lengths of stays of the psychiatric patient waiting for an inpatient psychiatric bed can affect the ED’s bed capacity.
The Mental Health Emergency Stabilization Initiative is an integrated team made up of Sutter-Yuba crisis behavioral health workers, as well as Vituity emergency telepsychiatry and ED staff. Working together, the team members can quickly complete a psychiatric assessment, evaluate any physiological health issues, provide a comprehensive treatment plan, including medications, and set up a comprehensive safety plan to assist the patient safe and successful return to the community.
Though the program is new, analysis of the initial six months of the program show it is significantly impacting and improving care. While the average volume of mental health patients over the last year has increased from approximately 40 to 145 monthly, the number of hours patients have to wait from the time they are seen to the time they are admitted to a mental health facility is down to 18 hours from a high of 27. As a comparison, at many hospitals, patients have to wait up to a week or more in the ED for admission. Such delays, often coupled with minimal care, can further worsen the mental illness of the patient.
Additionally, the assessment/treatment offered by the new program has reduced the number of inpatient hospitalizations, as well as cases of workplace violence seen in the ED. Positive financial improvements are also anticipated from the decreases in turn-around-times (TAT), nursing/sitter hours, worker’s compensation costs, and number of inpatient beds needed.
“The exciting part of the initiative is that our collaborative team approach has created a groundbreaking program that can be replicated at other Emergency Departments nationwide,” said Derek Orchard, D.O., medical director for the Rideout ED. “Our nation’s ED’s and mentally ill patients need and deserve a better approach to care. The team at Rideout is proud to be at the forefront of this highly promising and innovative program.”