(June 6, 2017) Along with forensic bed waits, boarding psychiatric patients in emergency rooms is one of the most widely recognized results of mental health bed shortages in the United States. Patients in psychiatric crisis commonly wait much longer than other patients in emergency rooms for treatment or hospital admission - sometimes days and even weeks.
In a new paper, Drs. Lara Chepenik and Edieal Pinker at Yale University propose this need not be the case.
Small Changes, Big Impacts
Chepenik and Pinker used queueing theory to model the impact of staffing changes on patient flow through a psychiatric emergency room at an unnamed university hospital. They found that a relatively small change - adding a single half-time clinician during the 8 am to 4 pm shift - resulted in significant improvements in several measures of the quality of care, including shorter wait times.
In the model, adding the half-time clinician cut average patient wait for before discharge from the emergency room by 35%, from an average of 13.7 hours to 8.9 hours. The average wait before hospitalization fell nearly 13%, from 38.1 hours to 33.2 hours.
In addition to reducing the total length of stay in the emergency room, the staffing change also reduced the number of patients waiting to be seen and the amount of time each waited to be seen by a provider. One of the unexpected domino effects of these reductions, the authors said, was that more patients could be seen and processed before nightfall, which reduced the likelihood they would remain overnight in the emergency room awaiting hospital admission.
"As patients enter the queue faster during the 8 am to 4 pm shift, the queue should be shorter, so those arriving later must no longer wait behind as many patients who had arrived previously," the authors reported.
Benefits of improved patient flow went "beyond relieving patient and staff frustration," the authors said. These include reducing the risk of patients leaving without being seen, which can worsen patient outcomes and reduce hospital income, and improving the likelihood of following through with referral to community resources.
Adding more staff beyond the half-time clinician produced no further improvements.
Echo of the "New Asylums"
The Chepenik-Pinker report in Psychiatric Services applied the same theoretical approach and computer modeling to emergency room wait times the Treatment Advocacy Center and University of North Carolina reported in our groundbreaking January 2017 proposal for reducing pretrial psychiatric bed waits in jails.
Emptying the 'new asylums': A beds capacity model to reduce mental illness behind bars found that, like adding a half-time staff member, computer modeling showed that relatively small changes in common policy and practice could dramatically reduce pretrial bed waits and the mass incarceration of individuals with serious mental illness.
Based on 2016 data from five sample states, Emptying the 'new asylums' projected that diverting two mentally ill offenders per month in Florida would reduce the average forensic bed wait in the state by 75%, from an average of 12 days to three days, and that reducing the average hospital stay from 189 days to 186 days in Texas would reduce forensic bed waits there from an average of two months to three days.
As our study of forensic bed waits also found, Chepenik and Pinker said using the model "helped elucidate the bottlenecks in this system and predict the potential effects of changes prior to commitment of resources."
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Chepenik, L. & E. Pinker. (May 2017). The impact of increasing staff resources on patient flow in a psychiatric emergency service. Psychiatric Services.
- Fuller, D.A., et al. (January 2017). Emptying the 'new asylums': A beds capacity model to reduce mental illness behind bars. Treatment Advocacy Center.
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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