St. Louis-based SSM Health has the highest capacity of psychiatric beds in Missouri. As a result, EMS providers often bypass other hospitals to bring patients directly to SSM for behavioral health services, Becky Dvorak, MSN, RN, regional vice president of behavioral health, told Becker’s. However, when emergency department wait times are long, patients may still face delays before receiving treatment.
“That has been a little bit of a challenge for us, because the emergency department is becoming so overloaded,” she said. “There are days where we can have 10 to 15 patients sitting in the ED waiting on an inpatient psych bed.”
To address this, SSM Health begins treatment while patients are still boarding. Nurse practitioners and psychiatrists are assigned to evaluate boarding patients via telehealth to initiate medication. While psychiatric medications do not provide instant relief, early administration can improve outcomes.
“Without telehealth, we wouldn’t be able to do the amount of consultations that we do. At DePaul alone, there were around 3,700 consults last year,” Ms. Dvorak said, referring to the 124-bed location, the largest behavioral health platform in the system.
A centralized intake team supports next-step decision-making. During intake, the team conducts an assessment. If outpatient care is deemed more appropriate, patients are connected with appointments through the EMR. The team also provides information on food banks, homeless shelters and other community resources, she said.
“Sometimes a patient will come to the emergency department with a diagnosis of a psych problem,” Ms. Dvorak said. “But a lot of times what they need is not necessarily any type of psychiatrist help. They need a lot of psychosocial services. They need help just getting set up on ‘where I am going to sleep tonight? Or how am I going to pay for food? How am I going to get my transportation?’”
Through a grant, SSM established an emergency room evaluation program for high utilizers, helping divert patients who do not require inpatient admission.
“Ninety-five percent of the time they don’t need to be admitted,” Ms. Dvorak said. “They’re just trying to get a need met; maybe they ran out of meds or couldn’t get to their doctor.”
Another strategy involves SSM Health’s behavioral health urgent care, separate from the emergency department. This facility, staffed by psychiatric nurse practitioners, nurses and social workers, offer care for patients who have run out of medication or could not secure a timely psychiatrist appointment.
“Getting into a psychiatrist could take months,” Ms. Dvorak said. “This helps meet the need early on instead of waiting four months and turning it into a crisis that ends up in the hospital.”
Historically, EMS could bill only for transports to the emergency department, not to urgent care. But thanks to some county grants, EMS providers can now be reimbursed for transporting patients to urgent care.
“The next hurdle is getting EMS comfortable with taking the right patients to urgent care and not someone who is completely psychotic and needs a higher level of care.”
The system does not yet have emergency department boarding data to share but is actively tracking metrics and expects the new strategies to have a meaningful impact over time.
