The swim lane diagram (see Figure 1) shows the process they developed.

Meanwhile, the LGH Hospital leadership team re-conceptualized the BH space altogether. Rather than serving as a holding area for acutely psychotic or suicidal patients waiting for placement, they created a small unit that follows the psychiatric assessment, treatment and healing (PATH) model. Figure 2 shows the newly conceptualized PATH model.

FIGURE 2. Click to enlarge.

Some of the features of this unit include:

• Ligature-free rooms and common hallway spaces
• Lockers to store patient belongings safely and privately
• Medication-reconciliation specialist in ED
• Security stationed in unit
• Duress buttons provided for every staff member
• Care team: ED registered nurse, BH intervention team (BHIT) member, psychiatry consults when applicable
• Laundry area in unit, overflow rooms with garage doors

The LGH ED overall and within the PATH unit has another innovative process to mitigate elopements. The Rauland call-bell system in the unit is enabled when the yellow E button is depressed.

When activated the PATH area becomes a locked unit. Patients who pose suicide or elopement risk wear bright yellow gowns for easy identification. The yellow E technology has proven to reduce and prevent patient elopements.

PIT has improved overall median length of stay (LOS) and earlier BH assessment. The data show that BH patients managed through the BHIT process in triage consistently have shorter LOS than BH patients managed using a traditional flow model.

The LGH leadership team invented a model for BH patients using available resources that could be replicated elsewhere. The Lancaster General Hospital ED is proud of its success in managing their BH burden; Bit by BHIT they know they have found the right PATH to do so!

Dr. Welch was a practicing emergency physician for more than 30 years and a research fellow at the Intermountain Institute for Health Care Delivery Research in Murray, Utah. She has written numerous articles and three books on ED quality, safety, and efficiency. She is a consultant with Quality Matters Consulting, and her expertise is in ED operations.