Emergency Psychiatric Assessment, Treatment, and Healing Units: Decreasing Violence, Increasing Throughput, and The Future of Emergency Mental Healthcare

Objective: : Patients with acute mental health disorders have few resources besides visiting the Emergency Department (ED). Once in the ED, they are often subject to inhumane treatments i.e., forced removal of belongings, intramuscular injections without consent, and physical restraining. Emergency Psychiatric Assessment, Treatment, and Healing (EmPATH) units offer an alternative to traditional emergency mental health treatment by providing a comfortable “milieu” experience. The objective of this evidence-based practice (EBP) study was to determine if an EmPATH like unit would decrease “as needed” behavioral control medications (e.g., Zyprexa, Ativan, Geodon), restraints, Length of stay (LOS), and increase ED Throughput when compared to the traditional emergency mental health treatment process.

EBP Model:: Iowa Model for Evidence Based Practice

Setting:: Teaching, Urban level III trauma center located in metro Detroit

Participants:: ED Nurses, ED providers, and boarded mental health patients.

Methods: : Recent studies show that EmPATH units decrease ED boarding times, LOS, psychiatric admissions, cost of healthcare, while increasing ED throughput and patient satisfaction.
Our hospitals EmPATH like unit (also called ED Annex) is a four-room, eight-bed unit off the ED. This unit holds boarded mental health patients awaiting psychiatry assessment or inpatient placement. Patients with significant disruptive behavior are excluded from the Annex to preserve the therapeutic milieu. The annex has four showers, a communal area with television, board games, creative activates, library, and pantry. Patient socialization is encouraged and attention to the healing milieu is priority. Finally, medical exams are performed daily and home medications are ordered/administered.

In this quantitative pre-post comparison EBP study four outcomes were measured, “as needed” behavioral control medications (e.g., Zyprexa, Haldol, Geodon) in the Annex unit versus the ED, restraint application in the Annex versus the ED, and LOS in the Annex versus the ED. Overall ED throughput was also measured. Comparing ED throughput prior to the Annex and after.

Outcomes: Projected outcomes for the Annex unit are a reduction in “as needed” behavioral control medications (e.g., Zyprexa, Ativan, Geodon) given in the Annex unit versus the ED. A reduction in restraint used in the Annex unit versus the ED is also projected. Third, time to discharge in the Annex unit was less than patients that remained in the ED. Finally, overall, ED throughput is projected to be increased because of the Annex unit.

Outcomes:: Projected outcomes for the Annex unit are a reduction in “as needed ” behavioral control medications (e.g., Zyprexa, Haldol, Geodon) in the Annex versus the ED, reduced restraint application in the Annex versus the ED, and reduced LOS in the Annex versus the ED. Finally, overall, ED throughput is projected to be increased post opening of the Annex unit.

Implications:: Implication of EmPATH units are, reduction of psychotropic medications (e.g., Zyprexa, Ativan, Geodon), reduction of restraint application, LOS, and increased ED throughput. Furthermore, mental health patients receive better, more holistic care. It is recommended that units with large mental health populations and or long boarding times create an EmPATH unit. The outcomes and implications above are anticipatory. Data analysis will be done when data collection is complete.