2023 14th Annual NUBE Conference

Increasing behavioral health patient volume, severity of illness, and decreased inpatient care resources have resulted in extended emergency department (ED) length of stay. Observation care has been a standard within emergency medicine for treating patients with diagnostic uncertainty or those who may benefit from protocol-based interventions to avoid admission. Historically in New York State, Behavioral Health patients have been excluded from observation care within medical Emergency Departments, instead being either rapidly admitted to inpatient Psychiatry or transferred to specialized CPEPs (Comprehensive Psychiatric Emergency Programs).Through close collaboration between Emergency Medicine, Psychiatry, Nursing, Social Work, and hospital leadership, BH Observation pathways were implemented in high-throughput space-constrained Medical Emergency Departments. The aim was to create a standard for short-term treatment, assessment, and re-assessment of behavioral health patients for whom diagnosis and determination concerning inpatient admission, discharge, or transfer was expected to take greater than 8 hours e.g. substance metabolism, dearth of disposition-determining collateral, extended medical workup, etc.In the pilot phase, patients treated without any increase in expense yielded a significant increase in facility and professional revenue, which could be re-invested in architectural and staffing enhancements for BH patients.  An expanded program would have the potential to reduce avoidable brief psychiatry admissions, creating inpatient capacity for higher-acuity ED BH patients throughout the system.

Learning Objectives:

1. Learn about Emergency Medicine Observation Care, including the benefits and challenges of applying this care model to Behavioral Health patients in Medical Emergency Departments.
2. Understand first-hand the role of the Emergency Medicine Physician, the Emergency Department Nurse, the Psychiatry Physician, and the Psychiatric Social Worker in Observation Medicine for BH Patients.
3. Learn how Observation Medicine was implemented for Behavioral Health patients in high-throughput space-constrained medical emergency departments in NYC, including key lessons-learned.