As emergency care providers, whether in rural Iowa or inner-city New York, we are all impacted by the shortage of inpatient psychiatric beds. Cost, quality of care, ED throughput, and patient safety are all negatively impacted by this crisis. Solutions,such as collaborating with community mental health services, educating ED staff about the management of the boarding mental health patient, and using telemedicine are all viable strategies that will protect a subset of ED patients who often cannot advocate for themselves.
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ACEP Now: Vol 33 – No 06 – June 2014Dr. Kitchen is an emergency physician resident R2 at the University of Iowa Hospital and Clinics in Iowa City.
References
- Torrey EF, Entsminger K, Geller J, et al. The shortage of public hospital beds for mentally ill persons. Arlington, Va: Treatment Advocacy Center; 2008.
- ACEP. America’s emergency care environment: A state-by-state report card 2014.
- Nicks BA, Manthey DM. The impact of psychiatric patient boarding in emergency departments. Emerg Med Int. 2012;2012:360306.
- Hickey L, Hawton K, Fagg J, Weitzel H. Deliberate self-harm patients who leave the accident and emergency department without a psychiatric assessment: a neglected population at risk of suicide. J Psychosomatic Res. 2001:50(2):87-93
- Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006:184(5):213-216.
- Sprivulis PC, Da Silva JA, Jacobs IG, et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006:184(5):208-212.
- Glover RW, Miller J, Sadowski S. Proceedings on the state budget crisis and behavioral health treatment gap: The impact of public substance abuse and mental health treatment systems. Special Congressional Briefing; March 22, 2012.
- Alakeson V, Pande N, Ludwig M. A plan to reduce emergency room ‘boarding’ of psychiatric patients. Health Affairs. 2010; 29(9): 1637-1642.
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One Response to “Decreased Public Mental Health Spending Raises Concerns over Psychiatric Patient Boarding”
July 6, 2014
benzonitAs a full time practicing EM doc, I suggest another solution; we can’t always cry “more more more” and expect to be part of the solution.
I see many of our inpatient psych beds occupied by drug and alcohol patients, voluntary and involuntary (court committed at, usually, family request.)
What is point here, keep them sober? Staying sober in the hospital is like staying non-pregnant in the cloister; there ain’t none.
I think we could sit down with court officers and help them understand this is a useless expenditure of public funds.
We would then free up psych beds.
Unfortunately for the hospital, we may just trade a paying bed (court committed and paid) for a non paying (public in need.)
That’s a discussion for another day.