The emergency department is certainly equipped to treat life- and limb-threatening emergencies. However, the traditional ED is not adequately resourced to treat patients with acute behavioral health concerns.
Even though one in eight ED visits is associated with behavioral health needs, only 17% of EDs staff mental health professionals. Given the limited number of psychiatric beds (the United States has an estimated shortage of 123,000 psychiatric hospital beds), these patients are often "boarded," waiting for appropriate care in a hectic environment that only exacerbates their symptoms. It's no surprise that patients with a psychiatric emergency wait three times longer in the ED than non-psychiatric patients, costing an additional $2,200 per visit.
To increase access for these patients and improve the quality of care they receive, four major health systems in Portland, Oregon (Legacy Health, Adventist Health, Oregon Health & Science University, and Kaiser Permanente) came together to create the Unity Center for Behavioral Health. This former hospital houses an outpatient psychiatric emergency services unit as well as 102 inpatient psychiatric beds.
Psychiatric emergency services units, or PES, provide quick stabilization in a calming environment built for people experiencing a mental health crisis. For instance, rather than using regular emergency beds, patients receive care in recliners from a multidisciplinary care team.
Patients can arrive to Unity via ambulance, police transport, or walk-in. Upon entry, staff conduct a clinical assessment to ensure their crisis is behavioral in nature. If deemed medically stable, the patient is brought to the PES unit, and if not, they are triaged to the most appropriate setting.
Connect patients to community care providers before discharge
During patients' stays, Unity is thorough in connecting patients to follow-up support. Some of these community care providers—such as outpatient addiction programs like CareOregon and residential mental health providers—are co-located at Unity Center so they can be introduced to the patient before discharge in person. Other community care providers are on-call. In those cases, Unity prompts the partners to send a staff member. For remaining community-based organizations, Unity offers warm handoffs to coordinate a referral prior to discharge.
Whether it is an in-person introduction to ongoing support or a warm-handoff at referral, over-communication with the patient and their care partners is key in smoothing the post-discharge transition. In fact, Unity Center is able to schedule a follow-up appointment for 80-90% of patients before they leave.
Offer peer support counselors as an affordable layer of longitudinal support
"Peer support specialists" are integrated in the PES and inpatient units to provide peer-to-peer support and comfort to patients by sharing personal experience about behavioral health problems and recovery.
For patients with multiple visits to Unity and patients experiencing their first psychiatric crisis, a "peer support specialist bridger" provides telephonic and in-person transitional support and follow-up tailored to the patient's comfort levels (e.g., home visits, phone calls, in-person meetings at coffee shops or community support groups).
Overall, this program has demonstrated incredible results. The Unity Center cut the number of hours partner hospital Legacy Good Samaritan Medical Center spent on ED diversion status due to overcrowding by 71%, resulting in a contributing profit margin increase of $1.6M. And this is all done efficiently—nearly 80% of patients treated by PES are stabilized and discharged within 24 hours.
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