Emergency Department

Emergency Department Throughput Solutions for Behavioral Health Patients

“Can we reduce the psychiatric boarding in the emergency department?”

“How can we improve the care and safety for patients with mental disorders or substance abuse problems in our emergency room?”

“How can we reduce delays in assessment and disposition for mental health patients in the ED?”


Reducing Psychiatric Boarding in the Emergency Department Operational Challenges

In our experience a number of issues contribute to the longer emergency department boarding times for psychiatric patients:

  1. Insufficient access to psychiatric inpatient beds and/or drug and alcohol treatment facilities
  2. High recidivism rate for patients with complex behavioral, physical/medical, and social needs
  3. Inadequate psychiatric staff coverage especially during peak times
  4. Physical space limitations, especially for reliable patient and staff safety
  5. Inadequately planned, utilized and coordinated community resources
  6. Adequate and consistently applied standards of care and safety protocols
  7. Access to non-emergency levels of care (e.g. partial hospital, observation bed, intensive out patient)


A National Issue

Psychiatric boarding and long wait times compromise the quality of care and safety for all patients, including those with a mental health or substance abuse problem.

Emergency Department administrators report they are often unable to transfer mental health patients to an inpatient facility in a timely manner. In our experience many psychiatric patients are boarded in the ED 24 hours or longer.


Background Statistics

Nationally, in addition to the high dwell time, estimates indicate one in every eight emergency department visits involves a diagnosis of mental health or substance abuse (HCUP Statistical Brief #92). According to the Agency for Healthcare Research and Quality’s Nationwide Emergency Department Sample (NEDS) report:

  • In 2010, mental illness as a “first listed diagnosis” in the CCS Classification system – including substance abuse disorders – accounted for 5,351,798 visits
  • Mental illness as one of all listed diagnoses, is identified in 40,517,931 visits; the top diagnoses listed:
    Screening and history of mental health and substance abuse = 15,731,158 visits
    – Mood disorders = 6,981,191 visits
    – Anxiety disorders = 4,307,870 visits
    – Alcohol related disorders = 3,333,104 visits
    – Substance related disorders = 2,693,163 visits
    – Delirium, dementia and amnestic and other cognitive disorders = 2,669,057 visits
  • Self-inflicted injuries accounted for 1.7% of all ED visits
  • 735,000 ED visits resulted in admission to an inpatient psychiatric or detoxification unit in the same hospital
  • 770,000 ED visits resulted in transfer to a psychiatric hospital


Our Approach

Our approach to reducing psychiatric boarding in the emergency department is active and hands-on. Since we are experienced in the operation of hospitals, we are acutely sensitive to the need to turn analysis into functional change that can be implemented quickly and seamlessly. Innovative solutions to psychiatric boarding are impacted by the following:

  • Emergency department capacity management procedures and technology for mental health patients
  • Dwell time reduction program for mental health and substance abuse patients
  • Analysis of community and regional needs and system planning to reduce psychiatric patient emergency department utilization and recidivism
  • Community resource mobilization / regional approach to improve care coordination for mental health and substance patients with high rates of emergency department utilization

Our Steps

To improve throughput and treatment quality for behavioral health patients in the emergency room, we conduct a thorough 3-5 day on-site evaluation. The evaluation is tailored to address the specific needs and challenges of your emergency department. Some typical steps we take to address those challenges during the on-site evaluation include:

  1. Initial Assessment to identify current barriers, existing opportunities, and workflow efficiencies
  2. Interviews with hospital leadership, nursing, emergency room physicians and managers, staff and community psychiatrists, community mental health and substance abuse center representatives, mental health advocates and other stakeholders
  3. Gap analysis to best practices and national benchmarks
  4. Collaborative development of an Action Plan

Our Deliverables

Following the 3-5 day evaluation period, our team develops a unique set of deliverables designed to improve the throughput and treatment quality of the behavioral health patient in your emergency department. Taken into account are the needs of the community, the patient population, and the hospital’s resources in meeting this challenge. You will receive:

  1. Opportunities and procedures to reduce psychiatric boarding
  2. Improved care and safety protocols for mental health and substance abuse patients in the emergency department
  3. Community resource utilization and development plan – e.g. care coordination, after care planning
  4. Written Action Plan with Implementation Steps and Timeline
  5. Action Plan implementation (Implementation by the client or by Schafer Consulting)
  6. Impact Monitoring using customized, unique measures
  7. Coaching of administrators on the use of the monitoring measures going forward


Emergency Department Benefits

Our team has answered the needs of emergency rooms by developing products that are unique to each facility. Following the implementation of the Action Plan, your emergency department will see the following benefits:

  • Improved care for psychiatric patients
  • Reduced emergency department psychiatric patient boarding and dwell time
  • Increased patient and staff safety
  • Compliance with state regulations and accreditation standards
  • Increased access to inpatient psychiatric and substance abuse treatment facilities and beds
  • Planned and coordinated use of community resources
  • Improved patient satisfaction
  • Better ED and hospital capacity management


Talk to Us

Over time, Schafer Consulting has developed tools that significantly improve emergency room services and efficiency when treating the mental health or substance abuse patients. Our success with emergency room focused projects results from connecting operations to real world business requirements and providing the client with unique tools to measure and track performance.

Uniquely focused in behavioral healthcare since 1993, we look forward to speaking with you about your specific emergency department needs. Call (724) 213-0200 or contact us in confidence.