2023 14th Annual NUBE Conference

On any given Monday throughout the U.S., emergency departments struggle with an overwhelming number of patients presenting with mental health crisis. The reliance on emergency departments (EDs) to provide psychiatric care has led to nationwide boarding and overcrowding bringing throughput to a near standstill as medical emergencies are forced to compete for ED resources.Collaboration between psychiatry and emergency medicine has emerged as a pivotal approach to address the complex and diverse needs of patients presenting with mental health crises in emergency settings. This presentation illustrates just how the synergy between these two specialties has proven to be highly effective in treating patients with psychiatric emergencies. It further explores the impact of collaborative practice to foster knowledge exchange and skill-sharing.  Evidence demonstrates that emergency department staff gain valuable insights into psychiatric conditions and psychiatrists develop a deeper understanding of medical conditions as well as exposure to the challenges of emergency care.  In 2014, a successful implementation of an emergency psychiatric team was launched in the second busiest emergency department in Massachusetts, focusing on innovative interventions, and collaborative approaches that provide timely and effective treatment and psychiatric stabilization. These services reduced the need for ED boarding by 32% and reallocated valuable resources to patients experiencing medical emergencies. Given the potential for self-harm or violence within the ED, the need for well-trained professionals capable of rapid assessment, de-escalation, and intervention in these critical situations to determine appropriate clinical pathways will also be discussed. Specific strategies and protocols will be outlined for optimizing emergency psychiatric care including the use of ‚ÄòPsychiatric Observation Status‚Äô for psychiatric emergencies within an ED setting, implementing ED psychiatric consultation services, applying the use of Psychiatric ESI protocols, and 2023 CPT professional codes for Observation and consults in an ED setting.Psychiatric observation serves four functions. It allows for the timely assessment and diagnosis of mental health conditions, as well as the initiation of appropriate interventions and treatments. Overall, psychiatric observation plays a crucial role in ensuring the safety, assessment, and initial management of individuals experiencing acute psychiatric symptoms. More importantly, it significantly reduces the need for admissions to psychiatric facilities, thereby preserving beds for the more acutely ill. Since observation is classified as a status, it can be implemented in any ED setting. Explicit steps to set up psychiatric observation status will be presented and include assessment, stabilization, and determination of appropriate disposition. The presentation will further describe implementing standardized protocols and facilitating timely psychiatric consultations. It will also examine the challenges associated with psychiatric observation, including staffing, resource allocation, and the need for efficient patient flow and coordination. In conclusion, collaborative psychiatry and emergency medicine represent a promising and dynamic approach to effectively address the complex needs of patients experiencing mental health crises as well as allow ED providers and staff to focus on care of medical emergencies.  By fostering interdisciplinary cooperation and integrating psychiatric expertise into emergency care, healthcare systems can improve patient outcomes, reduce psychiatric boarding, reallocate ED resources, and positively impact revenue.

Learning Objectives:

1. Understand the concept and importance of collaborative psychiatry and its integration into emergency medicine, including its potential benefits for patients, healthcare professionals, and the healthcare system.
2. Identify potential strategies to optimize psychiatric observation, such as implementing standardized protocols, enhancing staff training, and fostering collaboration between emergency medicine and psychiatric teams.
3. Develop proficiency in conducting rapid and accurate psychiatric assessments in emergency situations utilizing Psychiatric ESI principles.