Editor’s Note: This post is part one of our three-part series about new trends in emergency psychiatry. Next week’s article will focus on mobile crisis units and telepsychiatry. Two weeks from today we will discuss educational opportunities for emergency department staff members. To hear about new blog posts, follow us on Twitter, Facebook, Google+, or LinkedIn. 
Reports continue to surface indicating that psychiatric patients are overwhelming emergency departments (ED) nationwide. The surge is extending wait times for both psychiatric and non-psychiatric patients, impacting the timeliness of care provided, and affecting hospitals’ ability to generate revenue. At Emanuel Medical Center in Turlock, CA the number of patients with psychotic diagnoses presenting to the ED has doubled since 2007, according to an article in The Modesto Bee. Similarly, a recent study published by the American College of Emergency Physicians (ACEP) found that psychiatric patients spend an average of 11.5 hours boarded in the ED. “We know that general EDs are getting overwhelmed because of the contraction of inpatient and outpatient psychiatric services, and we know that it is affecting the length of stay patients have in the ED,” says Dr. Leslie Zun, Chairman of the Department of Emergency Medicine at Mount Sinai Hospital in Chicago. In fact, a recent Healthleaders Media Intelligence Report survey found that 46% of respondents said their ED is overcrowded, and 43% said improving patient flow was their greatest strategic challenge. To deal with the influx of patients with psychiatric needs, some facilities are implementing Psychiatric Emergency Service (PES) programs. According to the Healthleaders Media report, 42% of EDs surveyed have programs that focus specifically on psychiatric health issues. This post is the first in a series of three articles that will discuss some of the ways emergency medicine providers are implementing emergency psychiatric programs to improve patient care and ED throughput. Comprehensive Psychiatric Emergency Programs (CPEP) Some facilities have established dedicated emergency psychiatric programs called Comprehensive Psychiatric Emergency Programs (CPEP) to deal with the influx of patients with psychiatric needs. CPEPs are dedicated to treating individuals experiencing a psychiatric crisis. Individuals that typically present to the CPEP are either a danger to themselves or others. Some may have attempted suicide, attacked a person, or been found unfit to care for themselves. The typical CPEP is staffed 24/7 with psychiatrists, psychiatric nurse practitioners, and other mental health professionals. Psychiatrists are generally either onsite or readily available; however many different models exist. In some cases, CPEPs are an extension of a healthcare facility’s medical emergency department. St. Joseph’s Hospital in Syracuse, NY operates a CPEP program within the hospital’s Emergency Services Building. Other healthcare organizations operate the CPEP as a separate free-standing facility, such as the UHS facility in Binghampton, NY. Individuals who present to the CPEP receive a complete psychiatric evaluation, and if necessary can be held in certified emergency observation beds for up to 72 hours for additional evaluation. From there, individuals are either discharged home or to another mental health facility. A cost effective solution CPEP programs are a cost-effective way to treat individuals undergoing a mental health crisis says Dr. Scott Zeller, Chief of Psychiatric Emergency Services at Alameda County Medical Center and president of the American Association for Emergency Psychiatry (AAEP). “A good emergency psychiatric program can treat people in crisis and avoid hospitalization 70% of the time,” Zeller says. “Many of these patients would be automatically admitted if they presented to the medical ED,” Zeller adds. Quickly treating psychiatric patients and preventing inpatient admission is not only good for the hospital’s bottom line—psychiatric patients are typically underfunded or unfunded—it is what is best for the patient. In some medical EDs, psychiatric patients can spend days in the ED waiting for a psychiatric consultation. “That is not the best place for them,” Dr. Zun says. In many areas, CPEPs serve as regional psychiatric evaluation sites. In those areas, EDs transfer medically stable patients to the CPEP where the staff then treats patients and determines whether inpatient admission is necessary. The facility in which Dr. Zeller practices receives transfers from nine area medical EDs. “Having one regional CPEP decompresses area EDs and is a very cost-effective solution,” Dr. Zeller says, “One day in the CPEP is much cheaper than a psychiatric admission, which would rarely be shorter than three days.” In a 2008 survey conducted by the ACEP, 81% of respondents agreed that regional CPEPs nationwide would be better than the current system of boarding psychiatric patients in the ED. Regional CPEPs improve the emergency experience for both psychiatric and non-psychiatric patients. The programs ensure psychiatric patients quickly receive the care they need in the appropriate setting while also freeing up valuable emergency beds for non-psychiatric patients in the area’s medical EDs. They also help medical EDs move patients through the system more effectively and maximize patient volume. A growing trend Dr. Zeller estimates there are 200 dedicated CPEPs in the country. There are even more EDs that offer emergency psychiatric services in other ways, either with a dedicated wing or an emergency psychiatrist on staff. Those numbers are continuing to grow as more facilities learn about the benefits emergency psychiatric programs provide. About Barton Associates Established in 2001, Barton Associates is a leading national locum tenens staffing company serving psychiatrists, psychiatric nurse practitioners, and psychiatry practices across the U.S. from staffing offices in Massachusetts, Connecticut, and Florida. Learn more about Barton’s psychiatrist and psychiatry nurse practitioner staffing solutions and available psychiatry jobs at http://64.207.156.120. Barton’s other medical specialties include Anesthesiology, Dermatology, Emergency Medicine, Family Medicine, Hospitalist, Internal Medicine, Pediatrics, Primary Care, Psychiatry, Radiology, Surgery, and many more.
Reports continue to surface indicating that psychiatric patients are overwhelming emergency departments (ED) nationwide. The surge is extending wait times for both psychiatric and non-psychiatric patients, impacting the timeliness of care provided, and affecting hospitals’ ability to generate revenue. At Emanuel Medical Center in Turlock, CA the number of patients with psychotic diagnoses presenting to the ED has doubled since 2007, according to an article in The Modesto Bee. Similarly, a recent study published by the American College of Emergency Physicians (ACEP) found that psychiatric patients spend an average of 11.5 hours boarded in the ED. “We know that general EDs are getting overwhelmed because of the contraction of inpatient and outpatient psychiatric services, and we know that it is affecting the length of stay patients have in the ED,” says Dr. Leslie Zun, Chairman of the Department of Emergency Medicine at Mount Sinai Hospital in Chicago. In fact, a recent Healthleaders Media Intelligence Report survey found that 46% of respondents said their ED is overcrowded, and 43% said improving patient flow was their greatest strategic challenge. To deal with the influx of patients with psychiatric needs, some facilities are implementing Psychiatric Emergency Service (PES) programs. According to the Healthleaders Media report, 42% of EDs surveyed have programs that focus specifically on psychiatric health issues. This post is the first in a series of three articles that will discuss some of the ways emergency medicine providers are implementing emergency psychiatric programs to improve patient care and ED throughput. Comprehensive Psychiatric Emergency Programs (CPEP) Some facilities have established dedicated emergency psychiatric programs called Comprehensive Psychiatric Emergency Programs (CPEP) to deal with the influx of patients with psychiatric needs. CPEPs are dedicated to treating individuals experiencing a psychiatric crisis. Individuals that typically present to the CPEP are either a danger to themselves or others. Some may have attempted suicide, attacked a person, or been found unfit to care for themselves. The typical CPEP is staffed 24/7 with psychiatrists, psychiatric nurse practitioners, and other mental health professionals. Psychiatrists are generally either onsite or readily available; however many different models exist. In some cases, CPEPs are an extension of a healthcare facility’s medical emergency department. St. Joseph’s Hospital in Syracuse, NY operates a CPEP program within the hospital’s Emergency Services Building. Other healthcare organizations operate the CPEP as a separate free-standing facility, such as the UHS facility in Binghampton, NY. Individuals who present to the CPEP receive a complete psychiatric evaluation, and if necessary can be held in certified emergency observation beds for up to 72 hours for additional evaluation. From there, individuals are either discharged home or to another mental health facility. A cost effective solution CPEP programs are a cost-effective way to treat individuals undergoing a mental health crisis says Dr. Scott Zeller, Chief of Psychiatric Emergency Services at Alameda County Medical Center and president of the American Association for Emergency Psychiatry (AAEP). “A good emergency psychiatric program can treat people in crisis and avoid hospitalization 70% of the time,” Zeller says. “Many of these patients would be automatically admitted if they presented to the medical ED,” Zeller adds. Quickly treating psychiatric patients and preventing inpatient admission is not only good for the hospital’s bottom line—psychiatric patients are typically underfunded or unfunded—it is what is best for the patient. In some medical EDs, psychiatric patients can spend days in the ED waiting for a psychiatric consultation. “That is not the best place for them,” Dr. Zun says. In many areas, CPEPs serve as regional psychiatric evaluation sites. In those areas, EDs transfer medically stable patients to the CPEP where the staff then treats patients and determines whether inpatient admission is necessary. The facility in which Dr. Zeller practices receives transfers from nine area medical EDs. “Having one regional CPEP decompresses area EDs and is a very cost-effective solution,” Dr. Zeller says, “One day in the CPEP is much cheaper than a psychiatric admission, which would rarely be shorter than three days.” In a 2008 survey conducted by the ACEP, 81% of respondents agreed that regional CPEPs nationwide would be better than the current system of boarding psychiatric patients in the ED. Regional CPEPs improve the emergency experience for both psychiatric and non-psychiatric patients. The programs ensure psychiatric patients quickly receive the care they need in the appropriate setting while also freeing up valuable emergency beds for non-psychiatric patients in the area’s medical EDs. They also help medical EDs move patients through the system more effectively and maximize patient volume. A growing trend Dr. Zeller estimates there are 200 dedicated CPEPs in the country. There are even more EDs that offer emergency psychiatric services in other ways, either with a dedicated wing or an emergency psychiatrist on staff. Those numbers are continuing to grow as more facilities learn about the benefits emergency psychiatric programs provide. About Barton Associates Established in 2001, Barton Associates is a leading national locum tenens staffing company serving psychiatrists, psychiatric nurse practitioners, and psychiatry practices across the U.S. from staffing offices in Massachusetts, Connecticut, and Florida. Learn more about Barton’s psychiatrist and psychiatry nurse practitioner staffing solutions and available psychiatry jobs at http://64.207.156.120. Barton’s other medical specialties include Anesthesiology, Dermatology, Emergency Medicine, Family Medicine, Hospitalist, Internal Medicine, Pediatrics, Primary Care, Psychiatry, Radiology, Surgery, and many more.
