Healthcare News & Insights

Are mental health patients costing your ED big bucks?

There is one group of patients who visit your emergency department (ED) that can cause your costs to soar. Problem is, this group really doesn’t have a lot of choices available to them for treatment. Who are they?

They’re people seeking help for acute psychiatric illnesses.

The Foundation for Healthy Communities recently conducted a study to identify and document issues related to people who visit an ED for treatment of an acute mental health condition in communities throughout New Hampshire. While the study only dealt with New Hampshire EDs, this problem isn’t unique to the Granite state.

Study background

Twenty-six acute care hospitals in New Hampshire with EDs were asked to collect data on patients who were medically cleared in the ED, but needed an inpatient psychiatric admission. Eleven participated and submitted data for a minimum of eight weeks during the last quarter of 2012. The majority of these hospitals didn’t have inpatient behavioral health services.

The 575 people in the study were broken down into two age groups: 81% were 18 years old or older, and 19% were 17 years old or younger.

The data was broken down into three categories: total sample; people who waited 13 hours or more in the ED; and people who waited 24 hours or more in the ED.

As far as insurance goes, 77% had insurance. Forty-one percent of that group had either private insurance or Medicare, and Medicaid covered 36% of them. The other 23% were self-pay/no insurance. And there wasn’t a significant variation in wait times for insured and non-insured patients.

Key findings

While what the study found wasn’t shocking, it does identify a community need that isn’t being fulfilled, as well as an area that may be a major cost drain on many hospitals.

Some of the key findings include:

  • Nearly one out of three people waited more than 24 hours in a hospital ED for mental health treatment. The average waiting time was 2.5 days among this group of patients.
  • More than half of all patients recommended for an involuntary emergency admission for psychiatric care waited more than 24 hours in a hospital ED.
  • The primary diagnosis for more than 1 out of 5 patients was reported as suicidal and about one-third reported major depression, and
  • Seventy-eight percent of the patients required constant observation while waiting in the ED and 49% of the patients required special security.

Care costs

The 575 patients in this study only represent a small portion of the people with acute psychiatric illness that sought treatment  statewide at community hospital EDs. The lack of appropriate treatment facilities for these patients affects all ages and insurance statuses.

Because EDs are open 24/7, they are often the only place for this population of people to go, and many community hospitals don’t have inpatient psychiatric services. And treatments delays not only cost hospitals, but they can cause patients greater harm, too. Take, for example, these two cases which were reported in the study:

  • A man diagnosed with schizophrenia and bi-polar disease came to the ED. He required an involuntary emergency admission to the state hospital, but since no rooms were available for three days, he had to stay in the ED. Known to be violent, he had a 24-hour police detail (costing $5,184) for his security, and the safety of staff and other patients. Just being in the ED stressed the patient leading to violent outburst, which disrupted the treatment of other patients.
  • Another patient brought to the ED by police for an evaluation of mania and suicidal ideation was observed in the ED for approximately 130 hours. It cost $26,310 in personnel hours (one physician, one registered nurse and one ED tech) to have the patient observed. This included time for the paramedics and a security team who were called 14 times to the ED to assist the nursing staff when the patient became agitated. It didn’t include time that was spent by personnel coordinating physicians and mental health counselors to help meet the patient’s needs.

Not having a functional mental health system in place results can result in wasted revenue that doesn’t benefit the patient’s condition. Something has to be done to find a way to treat these patients without huge wait times, which endanger these patients, staff and other patients.

For a copy of the complete study, click here.



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