New psych unit eases patient burden in ED
A new psych unit, located within about 100 feet of the main ED at Vanderbilt University Medical Center in Nashville, TN, has freed up precious bed hours while improving staff and patient satisfaction.
"We are able to process about 250 patients through the unit per month," notes Greg Alberico, MeD, director of respond services at Vanderbilt Psychiatric Hospital, who heads the ED's Psychiatric Transition Unit (PTU).
Before the unit opened, the average loss for primary psychiatric patients was 10 hours, based on the difficulty of getting patients into the psychiatric hospital system in Tennessee, says Ian Jones, MD, assistant professor of emergency medicine and medical director of the ED. For example, you need two consultations, he says. "Freeing up that space gives us about 2,500 additional hours of bed time each month, and that's worth about $100 to $150 an hour," Jones adds.
From a respond perspective, they now are able to have all psych patients in one area, says Alberico, "When before you had to run all around the ED and look for them."
The faculty formerly was very distressed over the care psychiatric patients received, and the nurses had similar feelings, says Corey M. Slovis, MD, professor and chairman of the Department of Emergency Medicine. "This has changed the dynamic of how we approach psychiatrically ill patients," he says. "There's increased empathy, and doctors and nurses know the patients are getting into a place where they will have better care."
While the department didn't have good patient satisfaction data prior to the launch of the new unit, Slovis says his department now ranks in the 95th percentile when benchmarked against similar hospitals. "We do not believe that would be possible if there were still large numbers of psych patients all around our ED," he says.
No model available
While the staff saw a clear need for such a unit, they were surprised at what they found when they began to search for a similar facility to emulate.
Alberico says, "To be honest, when we began to look at building something that would still be a part of the ED but on the 'outside' of the department, we really couldn't find anything."
Nonetheless, he says, the team members thought it was important to go forward. "We believed — although we could not prove— that the amount of dissatisfaction among staff led to higher staff turnover," says Alberico.
Slovis says, "We were faced with a growing number of psychiatrically ill patients, or patients requiring addiction services, and they had to be in the ED — sometimes overnight — until we could arrange placement. Every patient was treated differently."
In the traditional ED layout, when there was a potentially suicidal or homicidal patient, each one required a minimum of one policeman or security guard, he says. "We might have had six or eight of these people in the department at one time, which created the aura of a jail rather than a university hospital ED," says Slovis.
Major renovations of portions of the old pediatric ED were required to create the unit. "It was a major challenge to come up with the construction funding, which was about $1 million," Slovis says. However, he made "a very persuasive case" to administration and cited the costs of occupied ED beds, as well as overtime money for police and security. In fact, in one month, that bill hit $25,000. The hospital decided to pay the costs for the new unit.
The present unit requires just one police officer and one mental health technician, who serve as a "go-between" for the ED and the respond area. "An ED physician maintains ownership of the patient at all times," notes Slovis.
Usually these patients never see an ED bed. They are interviewed in the waiting room, registered up front, and sent straight to the respond area. "Greg [Alberico] provides us with regular psych nurses in rotation, so the docs and nurses in our ED work with the same staff," notes Slovis. "This gives us very, very clear handoffs and collaborative work among colleagues, rather than passing patients between different groups."
This collaboration is critical, says Slovis. "The treatment plan is put in the EMR [electronic medical record], and sometimes the patient is turned over two or three times, but there's always someone in charge of medical care," he says. The techs give the meds, and a respond worker does the evaluation and communicates with various agencies.
The respond staff are master's-level clinicians: psychiatric nurses, RNs, or social workers, Alberico says.
Slovis says, "The beauty of this system is its really seamless transition. In one fell swoop, we totally eliminated these patients from the main ED and transferred them to a more secure and serene area with focused resources and much more appropriate care."
And with the significant cost savings, such a unit could lead to an impressive return on investment.
A new psych unit, located within about 100 feet of the main ED at Vanderbilt University Medical Center in Nashville, TN, has freed up precious bed hours while improving staff and patient satisfaction.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content