Letters to the Editor

Alternatives to the Emergency Department

TO THE EDITOR: The November Taking Issue column by Marvin S. Swartz (1) tackles the complex problem of emergency department (ED) boarding and its relationship to inpatient psychiatric bed capacity. As an organization specializing in facility-based crisis services, we are glad to see this issue receive attention and have the following comments:

Although the Smith et al. study (2) demonstrated that the poorest and sickest languish in EDs the longest, we disagree that there are “vanishingly few realistic alternatives.” Alternatives exist and increasingly are being adopted with positive results. Dedicated crisis centers with the capability to provide on-demand psychiatric assessment, intervention, and discharge planning are associated with reduced ED boarding and inpatient utilization, whether serving a specific ED (3) or a regional catchment area (4). Here in Arizona, a state with a long history of managed Medicaid and organized regional planning, such facilities can be found in every metropolitan area. We operate two of the largest, and in our experience the 23-hour observation model allows 60%270% of patients who would otherwise board in an ED (or jail) to instead transition to less restrictive and less costly community-based care...

To continue reading, download the full article below:

FURTHER READING

Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety

Background: Lean has been increasingly applied in health care

View
The Tucson Mental Health Support Team (MHST) Model: A prevention focused approach to crisis and public safety

ABSTRACT While Crisis Intervention Team (CIT) programs provide

View
The Banner Psychiatric Center: A Model for Providing Psychiatric Crisis Care to the Community while Easing Behavioral Health Holds in Emergency Departments

Abstract Banner Health in the Phoenix, AZ, metropolitan area

View
Provider-Payer Partnerships as an Engine for Continuous Quality Improvement

Those accountable for a system of care have an interest in

View
A Preventive Approach to Crisis and Public Safety

Effective collaboration between law enforcement and crisis

View
CRISES: A Framework for Developing Performance Measures for Behavioral Health Crisis and Psychiatric Emergency Programs.

Abstract Crisis and emergency psychiatric services are an integral

View
Every challenge is unique, so we tailor a solution that fits your needs.
Let us help.
Contact Us