Managing patients in the emergency department with mental health and substance use disorders

Abstract

With approximately 3% of the Houston Methodist Hospital Emergency Department’s (ED) 2017 annual volume presenting with resource-intensive psychiatric conditions, a 6-prong approach was applied to address the growing area of concern on how to best manage this unique population safely and efficiently through the provision of high quality care.  This approach included (1) the provision of dedicated care space, (2) placement of a trained team of providers and clinical staff, (3) contracting with a third-party, rapid-screen care team, (4) application of new technology, (5) instilling a partnership with the ancillary team, and (6) extending care after the hospital stay for better management of the longevity of the patients’ medical issues. Through these efforts, the overall time from ED arrival to ED departure for psychiatric patients who were discharged was reduced by 36%. In addition, the admit decision time to ED departure time for psychiatric patients was reduced by 30% from 2016 to the third quarter of 2017. Additionally, the number of violent patient incidents in the ED mental health unit was reduced to zero from 2016 to the third quarter of 2017, a number that is holding to date. Via the presence of heightened security measures, approximately 50% fewer security dispatches were requested in 2018 than in 2017. This is even more profound when considering the 9% growth in overall ED patient volume over the same time period. Thus, through the application of a multifaceted approach to the care of patients with mental health and substance use disorders presenting to the Houston Methodist Hospital ED there was an observed significant positive effect. Continued diligence to this topic in addition to further expanded resources are needed in both the community and clinical setting to mitigate the negative cycle of patients unnecessarily returning to the hospital or landing in jail that currently exists.