Unless ED staff are trained to recognize and respond to the underlying behavioral health issues that prompt some patients to show up frequently, the ED may become a revolving door for these patients, says Nancy Magee, BSN, MSN, RN, senior consultant for Novia Solutions.
“Emergency department staff have to improve their response to mental health problems. The healthcare professionals in the emergency department are very skilled at medical triage and treating physical disease, but many lack extensive training on how to respond to mental health issues,” she says.
“The staff in the emergency room wants to do the best for their patients, but often they lack the understanding and training to effectively manage the care of people with mental health issues,” she says.
ED case managers should look for underlying behavioral health issues while assessing patients, keeping in mind that frequent ED patients may have behavioral health issues that trigger their visits, Magee says.
Be aware that one in five patients has a substance abuse problem or a behavioral health need, says Patrick Hernandez, DBH, MSW, LMSW, CPRP, management consultant for Berkeley Research Group.
Since the emergency screening tools used most frequently focus on physical acuity and not behavioral issues, Magee recommends that ED case managers incorporate behavioral health screening tools into their assessments to help identify patients who could benefit from behavioral health interventions.
“There are several simple scales that case managers can utilize in the emergency department to quickly identify patients with mental health issues and incorporate their findings into the treatment plan,” Hernandez says.
He suggests the Patient Health Questionnaire-9 (PHQ-9), a self-administered tool to identify the progress of depression, and the Generalized Anxiety Disorder 7-item (GAD-7) scale to identify patients suffering from anxiety.
Case managers should educate themselves about the resources for the mentally ill in the community and develop relationships with them. “These partnerships can prove extremely valuable in getting patients the help they need in the community setting, reducing frequent visits to an emergency department,” Magee says.
EDs need to have social workers, and, in some cases, a psychologist, on hand to coordinate care with the case managers, she adds.
“Incorporating social workers into the emergency department case management system is extremely effective. Social workers have excellent assessment skills, they are knowledgeable about community resources, and they can do brief interventions on issues such as substance abuse. The physicians rely on them to help them assess the level of severity of mental health problems,” she says.
Magee recommends stationing social workers in the ED during peak hours. Determine when the most patients with behavioral health issues are in the ED and assign staff accordingly, she says.
Hernandez cautions against assigning case management duties to social workers who are not medically trained. “However, many social workers have experience with community resources, and relationships with community mental health organizations and inpatient psychiatric facilities that make them invaluable in developing a discharge plan for patients with behavioral issues. These social workers often can connect patients with a primary care practice that integrates behavioral and medical health, refer them to other outpatient mental health services, or facilitate a bed placement in a psychiatric hospital,” he says.
Unless ED staff are trained to recognize and respond to the underlying behavioral health issues that prompt some patients to show up frequently, the ED may become a revolving door for these patients.
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