Behavioral health extends far beyond the walls of a hospital. From housing to nutrition, when a patient’s everyday needs are unmet, their mental health can suffer.
At Hampton Roads, Va.-based Sentara, Tracey Izzard, vice president of behavioral health services, noticed a pattern: Certain patients were consistently returning to the emergency department for care. In response, she created a role to coordinate care on the floor and address wraparound services for patients.
The behavioral health navigator roles complement existing emergency psychiatry teams. As patients enter the emergency department, licensed therapists assess whether inpatient care, outpatient care or discharge is appropriate. The navigator’s primary focus is on bedside consultation, identifying resources patients need to stay in their community and providing bedside therapeutic interventions.
Currently, the system has one manager and 10 full-time navigators placed in each hospital.
“[Navigators] are behavioral health therapists,” Ms. Izzard said. “They understand all of the behavioral health needs, but they also focus on population health and the social determinant of health needs.”
Before the navigator role was implemented, the average emergency department length of stay was 2,740 minutes. In the first few months after implementation, it decreased to 2,090 minutes, she said. Thirty-day readmission rates also fell from 14.1% to 7.3% when navigators were engaged before discharge. Without navigators, 26.2% of patients returned; with navigators, the rate dropped to 14%.
“We’re supporting our workforce in the emergency department by adding this behavioral health specialist to the team,” Ms. Izzard said. “That kind of lowers their stress in that area by allowing us to pick up that piece.”
Ms. Izzard said the system has shifted from being reactive in emergency departments to proactive, with a stronger emphasis on community-based care.
A behavioral health navigator has also been placed in a freestanding psychiatric hospital to assist with scheduling patients’ seven-day, 30-day follow-ups, including immediate medication visits. Navigators also support families through care transitions, such as helping a child enroll in virtual school if they are not ready to return fully to the classroom.
“We helped a member linking them to community resources for utility assistance and furniture assistance, because these are all the things that are incredibly impactful and can be very destabilizing,” Ms. Izzard said.
The next step, Ms. Izzard said, is tracking patients to ensure they attend appointments and to answer any questions or concerns.
“We’re not just doing it for us, we’re doing it for the whole community,” she said
