University of Kentucky HealthCare based in Lexington opened an EmPATH unit in July 2024 to treat behavioral health patients outside its emergency departments — a design choice that differs from many EmPATH programs nationally.
The unit sits near Eastern State Hospital in Lexington and serves both of UK HealthCare’s EDs, at Good Samaritan Hospital and Chandler Hospital. About 5,000 patients a year come through its doors, and it has treated more than 10,000 people in its first two years — more volume than leaders initially expected, said Marc Woods, DNP, RN, chief nursing officer for Eastern State Hospital, the EmPATH unit and the Good Samaritan behavioral health unit.
The unit follows the EmPATH model developed by Scott Zeller, MD, though Mr. Woods said implementation varies widely by health system. “I think the statement is if you’ve seen one EmPATH, you’ve seen one EmPATH,” he said.
A model built on inclusion
UK HealthCare’s unit accepts patients other crisis programs might turn away, including those who are aggressive or violent, according to Mr. Woods and Lindsey Jasinski, PhD, chief administrative officer and director of psychology services at Eastern State Hospital.
“We use a statement of ‘find a way to say yes to this patient in front of you.’ Finding a way to say yes not just in fancy meetings or report offs — we say it to our staff. Traditionally in behavioral health, that hasn’t been the case,” Mr. Woods said. Dr. Jasinski described the shift as moving to “how do we operate on inclusion criteria,” rather than exclusion criteria.
Despite treating a broader patient population, Dr. Jasinski said restraint use on the unit is below 0.01%. She attributed that to staff building rapport with patients immediately, offering food and drink on arrival, allowing patients to keep their clothes and belongings when safe, and watching closely for signs of escalation throughout a patient’s stay.
The unit also employs peer support specialists — staff with lived experience of mental illness or substance use disorder — a role Mr. Woods said EDs typically lack. He recalled a patient telling him, “You don’t know what I’ve been through. You can’t help me,” before a peer support specialist stepped in and said, “He can’t, but I can, and I’ve been where you are.”
Suicidal ideation is the most common presentation, accounting for almost 60% of patients, according to Mr. Woods. Patients arrive by ambulance, police transport, family, rideshare, bus or on foot, Dr. Jasinski said, and the unit has drawn patients from roughly 30 states, though Mr. Woods attributed some of that reach to Lexington being a college town. If a patient presents at either UK HealthCare ED instead, staff arrange an ambulance transfer to the unit.
The program is built around a 23-hour observation stay. “Our No. 1 goal is that after 23 hours, you leave here with hope,” Dr. Jasinski said. “We’ve turned a crisis into an outpatient appointment.”
Very few patients progress to inpatient admission, Mr. Woods said, which he said helps preserve scarce behavioral health beds for the most acute cases. The unit has expanded capacity since opening with 12 chairs to roughly 20 today.
Fewer repeat visits, more follow-through
Leaders pointed to a decline in frequent ED use among behavioral health patients since the unit opened. In its first six months, Dr. Jasinski said, patients who had previously been coming to the ED an average of 5.5 times every six months were instead returning to the EmPATH unit about twice in six months.
Follow-up appointment attendance has also improved. Before the unit opened, patients discharged from the hospital attended follow-up appointments about 29% of the time, according to Dr. Jasinski; since then, that rate has held at 65% for two years. A community mental health center co-located inside the unit helps patients schedule follow-up care, typically within 24 to 48 hours of discharge, before they leave.
First-year data showed a 63.5% reduction in inpatient admissions and a 92.1% reduction in ED boarding time tied to the unit’s opening. Asked about year two, Dr. Jasinski said those operational gains have held steady, while Mr. Woods said tracking restraint use against ED baselines has been a harder metric to capture consistently.
“Each [readmission] is a new opportunity for us to reevaluate what that person needs,” she said. “We might start treatment, but the biggest thing that we do is connect them to those resources in the community.”
Kentucky has proposed using CMS rural health transformation dollars to fund additional EmPATH units across the state over the next five years, Dr. Jasinski said, citing the model’s effect on access to care. The unit also arranges transportation home for rural patients who arrive by ambulance but have no way to get back.
Effects on the emergency department
Before the EmPATH unit opened, Good Samaritan’s emergency department relied on four specially secured rooms within its 21-bed unit to hold behavioral health patients, Eric Reid, MD, Medical Director of Good Samaritan emergency department and medical director of EMS, said. The hospital also has a partnership with Eastern State Hospital that could typically move patients within about 12 hours.
Even with that arrangement, those rooms were routinely full during peak evening hours. Since the EmPATH unit opened, Dr. Reid said, it’s now rare for more than one or two patients to need those secured rooms at once, freeing space for other ED patients.
The timeline for behavioral health patients has also shortened: Providers can typically connect with the EmPATH team within about 30 minutes of finishing an ED evaluation, he said. Patients now often receive definitive care within an hour and a half to two hours of arrival — down from a typical three to four hours, and sometimes as long as eight to 10 hours, before the unit existed.
The change required upfront work, Dr. Reid said, including training EMS partners to manage behavioral health patients in transit and coaching ED staff on how to talk with patients about being transported to a separate facility without adding to their anxiety.
He also linked the model to less strain on ED staff.
“We often talk about the moral injury that leads to burnout in the emergency department, where we are trying to do the correct things for patients, but the system logistics around it make it difficult,” Dr. Reid said, adding that the EmPATH unit “is a great way to circumvent that.” He pointed to decreased use of restraints, sedatives and sitters as further evidence the model improved care rather than simply speeding it up. “It’s very satisfying to get these patients the care that they need,” he said.
Dr. Reid said other ED leaders considering a similar model should expect it to require sustained collaboration across disciplines, including standing meetings that bring together community-based providers, hospital staff and outpatient follow-up teams.
“It takes a lot of collaboration and communication,” he said, “but it really has had a great payoff.”
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