Data-driven strategies can streamline processes for psychiatric patients.
For years, behavioral health visits to emergency departments (EDs) have been on the rise, going hand-in-hand with a lack of community mental health resources and a shortage of inpatient psychiatric facilities.
These factors have led to increased boarding in the ED for mental health patients, and in turn have slowed ED patient throughput across the board. Slower throughput impacts hospital outcomes and profitability, as well as patient outcomes and satisfaction.
The ongoing COVID-19 pandemic has exacerbated preexisting mental health conditions and created new problems in patients with no history of mental health issues. Circumstances like grief and loss, isolation, overall stress, job loss, and financial difficulties have created many risk factors.
Overall, since the pandemic began, there has been a significant increase in ED visits due to mental health conditions, suicide attempts, overdose, and violence. EDs are struggling to keep up and straining resources to care for psychiatric patients.
Six Data-Driven Strategies
While there is no magic wand to handle the influx of psychiatric treatment needs, there are some incremental changes that can have a significant impact on patient flow. A careful analysis of historical and ongoing data trends using data analytics designed for emergency medicine can reveal which strategies may work best for an individual organization.
- Examine flow drivers. Many organizations do not use the same processes in behavioral units as they do in medical and surgical units. If that’s the case, it could be valuable to establish predictive discharge metrics in electronic health records (EHRs). This valuable data gathered from daily rounds and huddles can let the ED know when beds are opening up. Ongoing capacity and flow data can help reduce bottlenecks and increase transparency between departments.
- Increase training on the severity of psychiatric disorders. Distinguishing between mild cases — which might be treated without heavy medications, patient restraints, or the use of scarce specialists — and more severe cases has become a helpful skill set for EM physicians to acquire. Less severe cases can be discharged more quickly and referred to outpatient resources, thereby reducing ED crowding. With supportive training, EM physicians can determine which cases urgently require greater intervention and scarce behavioral health experts from those that do not.
- Establish and track urgent outpatient appointment slots. Mental and behavioral health patients are more at risk for high ED utilization, repeat visits, and readmissions. Establishing urgent outpatient follow-up within 24 to 48 hours increases the likelihood of successful outpatient treatment. Working closely with outpatient providers to identify available appointment slots is an important strategy for preventing future mental health crises.
- Aligning case management with ED peak placement times. An ED is open 24/7 but case management often is not. Gathering facility data and aligning resources with peak times can reduce time spent waiting for case management to arrange disposition.
- Using telehealth for psychiatric consults. Each patient needs a psychiatric consultation to determine the patient’s safety and an optimum disposition plan. Patients often wait hours in the ED for a busy psychiatrist, especially during off-peak hours when fewer physicians are available. Organizations have found that using telehealth for psych consults:
- Reduced unnecessary transfers
- Decreased length of stay
- Improved patient and family satisfaction
- Decreased costs
- Led to consistent quality of care
- Using nurse-driven protocols to facilitate medical clearance. When mental health patients need to be transferred to outlying facilities, a protocol of tests is required to assure medical stability before discharge. Rather than wait on those orders, a nurse-driven protocol can facilitate that process as the patient is being prepared for transfer.
Deciding which of these strategies may work for any one organization requires advanced analytics solutions that can identify areas ripe for improvement and monitor the impact of process adjustments or program implementation. EDs around the country are searching for solutions to cope with changing patient mixes and increased volumes. It is a critical challenge – not only for behavioral health patients, but for all patients coming through the ED and waiting for a bed. Situations in each community and health care organization are different, requiring specialized, tailored solutions.
Personalized data strategies designed by d2i deliver the crucial information needed to form a solid action plan. No more guessing games — with the right data, leaders gain an enhanced understanding of each piece of the ED process and can create effective strategies moving forward. Contact d2i for more information.