In­ter­moun­tain’s be­hav­ioral health cen­ter de­creases ED use, un­nec­es­sary ad­mis­sions

Modern Healthcare - - Best Prac­tices - By Maria Castel­lucci

As In­ter­moun­tain Health­care’s McKay-Dee Hos­pi­tal saw an in­flux of pa­tients with be­hav­ioral health needs, it strug­gled to ad­e­quately treat them.

In a five-year pe­riod, the hos­pi­tal in Og­den, Utah, ex­pe­ri­enced a 33% in­crease in the num­ber of pa­tients it eval­u­ated for a be­hav­ioral health cri­sis from 3,997 as­sess­ments in 2012 to 5,325 in 2017. Most of those eval­u­a­tions were done in the hos­pi­tal’s busy emer­gency depart­ment, where pa­tients could ex­pe­ri­ence long waits be­fore they were seen by a spe­cial­ist.

“EDs are not con­ducive to pa­tients who are in a cri­sis and strug­gling with a men­tal ill­ness,” said Shelly Read, direc­tor of be­hav­ioral health at McKay-Dee.

Wor­ried about how quickly and ap­pro­pri­ately it was treat­ing pa­tients, McKay-Dee in April 2017 opened a cen­ter specif­i­cally for those ex­pe­ri­enc­ing a men­tal health cri­sis.

The Be­hav­ioral Health Ac­cess Cen­ter is lo­cated across the street from the hos­pi­tal’s ED and staffed with be­hav­ioral health spe­cial­ists 24/7. It treats pa­tients age 18 and older who need help im­me­di­ately, said Clint Thur­good, be­hav­ioral health con­sul­tant ser­vices man­ager at McKay-Dee.

“It’s a way to stream­line ser­vices,” Thur­good said. “We want th­ese pa­tients to avoid the ED so they can be seen more quickly and be linked up with the ap­pro­pri­ate providers.”

Pa­tients who seek care at the ac­cess cen­ter are ini­tially as­sessed by a nurse trained in be­hav­ioral health and an ED physi­cian. The doc­tors pro­vide a typ­i­cal phys­i­cal exam to en­sure there are no other un­der­ly­ing con­di­tions that need at­ten­tion. Work­flows have been ad­justed so ED doc­tors have the time to see the pa­tients in the ac­cess cen­ter. And be­cause the cen­ter is lo­cated so close to the ED, it’s easy for the doc­tors to go from one lo­ca­tion to the other, Thur­good said.

The nurses eval­u­ate the na­ture of the pa­tients’ be­hav­ioral health needs and de­ter­mine the most ap­pro­pri­ate ser­vices. A psy­chi­a­trist is avail­able to pro­vide im­me­di­ate coun­sel­ing. Fam­ily mem­bers are usu­ally present and in­volved in dis­cussing the pa­tient’s symp­toms.

The nurse may also de­ter­mine that the pa­tient should be ad­mit­ted to McKay-Dee’s in­pa­tient be­hav­ioral health unit. But Thur­good said most of the pa­tients won’t need to be ad­mit­ted to the hos­pi­tal. Typ­i­cally, pa­tients are suf­fer­ing from anx­i­ety, de­pres­sion or con­tem­plat­ing sui­cide. Pa­tients who are dis­rup­tive, vi­o­lent or ex­pe­ri­enc­ing an over­dose will likely be trans­ferred to the ED.

The over­all ex­pe­ri­ence at the ac­cess cen­ter is de­signed to be more calm­ing than the ED, Thur­good said. Staff strive to keep the fa­cil­ity quiet and in­stead of hos­pi­tal beds pa­tients sit on couches. Pa­tients also don’t need to change out of their clothes and into a hos­pi­tal gown.

“It doesn’t look like a tra­di­tional ED,” Thur­good said. “It’s a more calm­ing en­vi­ron­ment—not a lot of hus­tle and bus­tle. There are no TVs.”

Li­aisons trained in so­cial work as­sist pa­tients with a host of post-visit needs, in­clud­ing co­or­di­nat­ing fol­low-up care. They also have con­nec­tions with lo­cal com­mu­nity be­hav­ioral health providers and re­sources. Cost con­cerns are dis­cussed as well. The li­aisons are trained to help those with no in­sur­ance.

“The men­tal health sys­tem is re­ally dif­fi­cult to work through—pa­tient li­aisons help them nav­i­gate that very dif­fi­cult sys­tem,” Read said.

The cen­ter has de­creased the num­ber of pa­tients with be­hav­ioral health con­cerns seen in McKay-Dee’s ED. About 50% of be­hav­ioral health pa­tients are treated at the cen­ter. In March, the fa­cil­ity saw 208 pa­tients while the ED saw about 200.

McKay has raised aware­ness in the com­mu­nity about the cen­ter by in­form­ing lo­cal be­hav­ioral health providers and pri­mary-care prac­tices.

“It’s a lot of word of mouth now,” Read said.

The cen­ter has the added ben­e­fit of lower costs for the pa­tient be­cause it’s billed as an out­pa­tient ser­vice in­stead of an ED visit, Thur­good said.

Ad­di­tion­ally, the cen­ter has de­creased the like­li­hood that pa­tients will be ad­mit­ted to the hos­pi­tal be­cause they are seen quickly by providers with the ex­per­tise to iden­tify the pa­tient’s im­me­di­ate needs, he said. In­ter­moun­tain has now opened two other ac­cess cen­ters in its sys­tem.●

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