By Cheryl Portner, RN, MSN
Vice President, Staff Development & Training
Decades ago, ED patients who needed psychiatric care experienced long waits for evaluations, cramped accommodations, a lack of privacy and frequent transfers to other facilities. But healthcare delivery was changing — hospitals were downsizing and closing their psychiatric services, access to inpatient psychiatric beds was decreasing, and patients were shying away from EDs that didn’t have inpatient psychiatric units. Instead, they were going to EDs at facilities that had inpatient beds, where they knew they would not be turned away and could stay until a bed became available. Often that meant a stay of 48 hours or longer in the ED, increased strain on hospital resources and less than optimal patient care. In addition, the national healthcare dollar was shrinking and the number of psychiatric patients coming to EDs was on the rise and the list of places available to care for them was getting shorter and shorter — all problems in need of solutions.
One of the solutions that emerged in recent years that has had a positive effect on quality of care in the ED for this patient population is the dedicated psych emergency unit.
Designed with safety as a priority and staffed with trained behavioral health professionals, psych EDs have become a positive trend in psychiatric emergency care. They provide patients with a quiet, private and non-threatening care environment in which they can receive the medication and immediate treatment they need. No matter how much a patient’s behavior escalates or how much intervention he or she needs, trained and dedicated staff can help.
Psych EDs serve patients who are experiencing everything from acute manic or depressive episodes, to substance abuse issues, drug-seeking behavior or suicidal thoughts. In the past, patients who presented with serious behavioral issues or who were experiencing acute psychotic episodes may have been placed in restraints. Today, they are treated in compliance with new standards and regulations regarding physical and chemical restraint interventions that often are based on years of research on appropriate measures. Patients diagnosed with medical problems on top of their mental health issues can be admitted to a medical unit and provided with a 24-hour “sitter” who helps ensure the patient’s safety and well-being. When there is no medical issue needing immediate attention, the patient is placed in an ED bed until transfer or placement can take place. If the patient lacks healthcare insurance, case managers and social workers arrange transfer to an appropriate facility.
Increases in mental health illnesses in the overall population can lead to increased mental health-related ED visits, but when those visits occur, psych ED units are there with quick and correct assessments, appropriate treatment and interventions, and referrals for follow-up care. This timely care can reduce the length of inpatient stays and the frequency of return visits — and the related high costs of ED care for patients.
These units may be intense and stressful environments for staff, but for the patients they care for, they are the “calm in the storm” and “safe havens” that are providing some great new solutions to some serious old problems.
Read this Nurse.com feature for more information:
Easing the mind: Patients who come to the ED for mental health issues can need lifesaving care
Continuing education resources: