The issue of ED boarding – holding admitted patients in the ED – has reached “public health emergency” levels according to the American College of Emergency Physicians. The crisis is especially acute for patients experiencing a mental health emergency who wait on average three times longer in emergency rooms than those with medical needs.
For those experiencing an acute psychiatric episode, the experience can lead to a number of consequences, including poorer outcomes. For hospitals, they can be financial (losses), operational (inefficiencies) and clinical (burnout). One analysis estimated the annual financial loss at one large academic hospital of patient boarding to exceed $1.7 million.
Like so many in healthcare, this problem carries complexity and nuance, and cannot be solved with a one-solution-fits-all approach. With an increase in the number of people that need mental healthcare (nearly 6 million adults went to the ER for mental health emergencies in 2021) and a shortage of the providers who can deliver that care, each region and hospital face their own challenges based on the needs of their unique community. That said, telemedicine can offer an almost immediate solution that addresses many of the negative consequences for both patients and hospitals. With psychiatrists and psychiatric mental health nurse practitioners available through telemedicine, hospital ED staff can have a trusted source of psychiatric expertise available 24/7, as needed, to diagnose, stabilize, and transfer patients in crisis while reducing ED wait times for all patients.
For hospitals and health systems with ED-based virtual behavioral health resources, the results are measurable and significant
When patients are experiencing an acute psychiatric crisis, being stuck in an emergency department waiting room or hallway can be overstimulating and one of the worst places for them to be. With telemedicine, we are able to get more patients the care they need faster by evaluating patients within a few hours of them entering the hospital, not days.
Decreased length of stay
Before implementing telepsychiatry, patients who required behavioral health evaluations in the emergency department at Allen Hospital, a 204-bed not-for-profit community hospital in Waterloo, IA, faced extended wait times and were often boarded in hallways or scattered in rooms throughout the ED. Once the hospital’s three-pronged approach – which included emergency and inpatient virtual behavioral health consults – was implemented, patients saw their average length of stay decrease by nearly 12 hours.
For CaroMont Regional Medical Center in Gastonia, NC, the increased volume of
behavioral health patients was diverting resources away from other emergency patients. Following the successful implementation of virtual behavioral health, the medical center reduced the length of stay for psychiatric patients by 70% in the ED and increased the
medically appropriate discharge rate to 65%.
Increased return on investment (ROI)
With the telemedicine program in place, Allen Hospital’s patient and provider experience have both seen significant improvement, as has ED throughput overall. Importantly, the hospital avoided more than $1.7 million in annualized boarding costs and saw an annual return on investment of 281%.
Reduced admission and transfer rates
For CaroMont Regional Medical Center, the positive impacts of the telepsychiatry program extended beyond the ED; they saw a reduction in transfer rates to just 9%, allowing patients to receive the care they need closer to home.
For Allen Hospital, the changes reduced the admission rate by 4%, and the time it takes to do consults has plunged dramatically, down to 2-3 hours per day.
Best practices when setting up a virtual ED solution
While every environment is unique and will therefore require an approach that works for their team, physical layout and patient community, there are a few best practices to consider when implementing a virtual behavioral health solution.
- Identify and build a behavioral health response team, comprised of on-site personnel and virtual professional psychiatric staff.
- Reorganize the space in the ED to make room for an emergent behavioral health unit. Consider ligature-free rooms and a crisis observation area.
- Find the right resources and/or partners to close the shortage of clinical resources gap.
Beyond the ED: Telemedicine plays a critical role in outpatient clinics and behavioral health hospitals
With the significant increase in demand for mental health services across the U.S., we need to find effective solutions that go beyond the emergency room. While many acute health experiences begin there, communities can leverage telemedicine to create a holistic system of mental health services.
Clinics and primary care
With 60 to 80 percent of primary care visits including a behavioral health component, patients increasingly expect their pediatricians, internal medicine, and family practice physicians to be able to help with behavioral health symptoms and challenges. When resources are hard to find – e.g., as a result of the aforementioned provider shortage – telemedicine can be the difference between meeting a patient’s behavioral health care needs internally or referring them to an external specialist.
Specifically, it can lead to reduced wait times, improved patient outcomes, removal of barriers to care and more empowered, satisfied care teams.
Behavioral health hospitals
The shortage of mental health providers is not just hitting hospital emergency rooms; it is also impacting behavioral health hospitals. The care those hospitals provide is critical to their communities, but finding providers is hard (or impossible), a virtual team of MDs and PMHNPs can address the growing need. A team of high-quality virtual providers can handle all professional psychiatric care from admissions, to daily rounding, PICU consults and 24/7/365 on-call coverage and can lead to increased census, continuity of care and improved patient experience.
Whether in an emergency room, outpatient clinic or behavioral health hospital, the role telemedicine can play in addressing Americans’ growing mental health needs is significant. For patients, it can not only transform their experience, but dramatically improve their health outcomes. And, for hospitals and providers, it can drive measurable bottom-line results in a time when every dollar matters to keeping their doors open.