The boarding of patients in the emergency department continues to plague hospitals. But could a registry of psychiatric bed availability help ease the problem?
More than 12% of emergency department (ED) visits were for mental health, substance abuse conditions, or both in 2007, according to government data, and those patients were two-and-a-half times more likely to be admitted to the hospital than ED patients with other conditions. But there are fewer and fewer beds available for these patients.
Dr. Richard Alcorta
Nationally, there are about 26.1 inpatient psychiatric beds per 100,000 patients, down from 29.9 in 2009, according to a report from the American College of Emergency Physicians. And experts say that around 50 beds/100,000 are actually needed to meet the current demand.
The result is that patients experiencing a mental health crisis are often boarded in the ED with limited or no psychiatric treatment for hours or days.
Some states are looking at psychiatric bed registries as a way to quickly identify needed beds and ease the ED backlog.
Virginia is the latest place to begin using an online system to track the availability of inpatient psychiatric beds. In March, the Virginia Acute Psychiatric and CSB Bed Registry went live, providing data on open beds at public mental health hospitals, private hospitals, and crisis stabilization units throughout the state. The website, which is run in partnership with the state hospital association, is updated daily.
The site is designed to aid clinicians who are trying to place individuals in mental health crisis who are under an emergency custody order and need to receive treatment under a temporary detention order. All crisis stabilization units and state hospitals are required to participate in the bed registry, but private hospital participation is voluntary.
Virginia isn’t alone in exploring this solution. Neighboring Maryland has had a bed registry in place for a little over a year. And Minnesota launched a statewide registry in 2007. Other states also have bed registries, but there is large variation in the number of facilities they cover and how often they are updated.
Emergency physicians in Pennsylvania are asking their state legislature to create a registry, saying it would help cut down the time patients in mental health crisis spend in the ED generally with little or no treatment for their psychiatric conditions.
"You can go online at the Home Depot and find out if they have a certain product in the store near you or if you have to go to the next county over," said Dr. Charles F. Barbera, chairman of emergency medicine at Reading (Pa.) Health System and president of the Pennsylvania chapter of the American College of Emergency Physicians (ACEP). "But, for medicine, we don’t have a lot of that" capability.
Aside from the waiting, the lack of a statewide registry puts a burden on the ED staff, Dr. Barbera said. "What we wind up doing is getting on the phone and basically calling until we get lucky," he said.
That kind of time-consuming and haphazard bed shopping is what prompted emergency physicians in Maryland to seek a registry in 2012, said Dr. Richard Alcorta, an emergency physician and medical director for the state’s Emergency Medical Services, part of the Maryland Institute for Emergency Medical Services Systems.
Dr. Leslie Zun
Working with the Maryland Hospital Association and the state’s ACEP chapter, EMS officials there developed an online system that allows inpatient facilities to post their available psychiatric beds and emergency departments to post about patients in need of placement.
But the roll out of the registry has been a bit rocky, said Dr. Alcorta, a past president of the Maryland chapter of ACEP.
Participation in the registry is voluntary and its success relies on a critical mass of hospitals being willing to post their availability at least twice daily. At its peak, participation by inpatient facilities and EDs was around 30%, Dr Alcorta said.
Part of the problem is that the registry launched in November 2012, right as state officials and hospitals were coping with the arrival of Superstorm Sandy. That set back their training programs by several months.
The dilemma for state officials is that if inpatient facilities don’t post beds, EDs won’t post patients, and vice versa. Aside from providing a practical tool for patient placement, higher participation would give state officials much-needed data about whether there is a general lack of inpatient psychiatric beds. "I can’t answer that question today," Dr. Alcorta said.
In Minnesota, they’ve had better luck getting buy-in for the registry system. Their bed registry, which was launched in 2007, now has close to 100% participation by hospitals that report up to 3 times a day to keep the data fresh. They even expanded the registry to include crisis service providers and community-based services such as intensive residential treatment and crisis residential treatment.