Gwinnett Medical Center has seen the number of mentally ill patients coming into its two hospitals' emergency departments swell by 20% annually over the last several years, despite only having a 1% overall rise in ED visits.
"It's not a good place for those patients to sit," said Michael Boblitz, vice president for planning and business development for Lawrenceville, Ga.-based Gwinnett Medical Center. "For that population, you want to keep it calm and quiet, and in the ER it's not really the quietest atmosphere."
This week, the health system will open a new 5,000-square-foot specialized behavioral health holding unit that can hold up to eight patients at a time and they can be monitored 24 hours a day, Boblitz said.
Gwinnett's leadership team decided to invest in this issue two years ago, doling out nearly $3 million to create the new unit adjacent to the emergency department where patients can be monitored and cared for by behavioral health professionals while they wait to be transferred to another facility.
Boblitz said a full-time staff of behavioral healthcare professionals Gwinnett contracts with to handle such cases will triage patients within the unit while some of the system's ED nurses will be assigned to provide for their medical care needs.
Holding psychiatric patients within an emergency department has been a growing problem for hospitals across the country for years as the number of facilities that provide specialized behavioral and substance abuse treatment services have dwindled. The number of staffed beds at state psychiatric hospitals has declined by about 95% over the past 60 years from more than 558,000 in 1955 to around 35,000 in 2016, according to a report by the Treatment Advocacy Center, with nearly half of beds available today occupied by those who have committed crimes.
Hospitals have been looking for ways to transfer mentally ill patients more swiftly to appropriate psychiatric care from their EDs, since providers often aren't reimbursed for holding those patients. Holding such patients often requires hospitals to dedicate resources and divert staff from treating other patients, which can lead to significant delays in delivering care.
While larger health systems have approached the problem by increasing their own capacity to treat more patients with behavioral health and substance abuse issues, smaller and more rural providers often do not have the resources to offer such services.
The influx of patients with behavioral health disorders coupled with an overall shortage of available inpatient psychiatric beds in the area has forced the community safety-net provider to hold an average of 10 to 11 mentally ill patients in its emergency department per day, and those stays can last a week or longer before they can be transferred to a treatment facility.
Gwinnett Chief Operative Officer Thomas Shepherd anticipated the move would allow the ED to treat more patients who don't suffer from mental illness. Overall, he expected the investment in infrastructure and staffing to be a wash for the hospital at least in the short term when compared to what it cost the hospital previously to board such patients.
"It's really a care quality and safety issue for the patient and for our staff," Shepherd said.
He said the hope was the model will eventually result in shorter lengths of stay as a team of care coordinators will be dedicated to the unit to focus on getting patients transferred to a psychiatric facility more quickly. "The whole idea is to get them out of the ED and get them somewhere they need to be."
