Healthcare News & Insights

One hospital’s approach to saving costs when treating mentally ill patients

Hospitals across the country are taking steps to control one costly aspect of care: treating mentally ill patients in the emergency department.

HospitalAn article in the New York Times describes one hospital’s attempts to curb unnecessary ED use by those with mental illness, a problem that’s widespread in the U.S. In fact, data quoted in the article from the Agency for Healthcare Research and Quality states that in 2010 (the most recent year for which numbers were available), 6.4 million emergency department visits were due to mental illness or substance abuse.

Tweaks to staffing, training

WakeMed Health and Hospitals is a large, regional hospital system in North Carolina, a state that has a larger-than-average volume of mentally ill patients admitted to the ED. The hospital itself treats close to 314 patients with mental illness each month. Admitting these patients is usually not the best choice for their conditions, but few alternatives existed until the hospital took initiative to improve the situation.

As a way to cut back on the number of patients with mental illness filling its ED beds, WakeMed is piloting an innovative program designed to improve the continuum of care for the mentally ill.

To steer these patients toward programs better suited to meet their needs, the hospital started by hiring 14 behavioral health specialists and four patient service assistants. Their sole purpose is to find space at more appropriate facilities for mentally ill patients once they first seek treatment at WakeMed.

Also, the hospital’s invested in providing private transport for patients to mental-health facilities. And it’s provided training to first responders who transport patients to the hospital via ambulance. Paramedics responding to calls from people seeking treatment now ask them several questions to determine their mental state.

After the screening, patients are still given the option to visit the emergency department if they’d like, but paramedics also let them know that they can go to another facility that can better help them with their specific problem.

In a year of using the new approach, more than half of the patients who showed signs of mental illness and were transported to the ED requested to be taken elsewhere for treatment.

Other options for hospitals

Though obstacles exist to using this strategy nationwide, mainly due to limitations from federal healthcare programs and state laws governing where patients can be taken by ambulance, certain aspects can be adapted for use in most emergency departments, most notably providing a brief mental health screening to all patients prior to admission.

Besides WakeMed’s approach, the article describes other changes hospitals have implemented to improve care for mentally ill patients, including creating a separate psychiatric emergency department or a smaller mental health emergency room extension to reduce the strain on the general ED.

Strategies like these may be key to curbing the continually rising healthcare costs incurred by the mentally ill. And they’d help hospitals do more with their limited resources by directing these patients to more appropriate facilities for care.

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