Lalithkumar Solai, MD, chief of mental health at Medical University of South Carolina in Charleston, told Becker’s how the system is transforming emergency department triage for behavioral health patients through the use of EmPATH — emergency psychiatric assessment, treatment and healing — units with the aim of freeing up a full emergency department.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: How do you see EmPATH units changing the game in emergency rooms to triage behavioral health patients? Would you encourage leaders to incorporate these units?
Dr. Lalithkumar Solai: I would encourage every system to consider EmPATH units to be part of the emergency departments space, if they can build it. It is going to facilitate the patient coming into the emergency room and waiting in the emergency room to see psychiatry. If we can move them into a safe space, like an EmPATH unit, then before the clinician comes and sees them, the therapeutic environment that they are in should help in calming them down, and hopefully will help them stabilize better.
First, it can make sure that the medical emergency room has beds available for medical emergency patients. It will be very helpful for them to have those beds. It is very frustrating for the emergency room physicians and clinicians that psychiatry was clogging up their beds. They had patients in their waiting room, so moving them into the unit will quickly create the space that they need. It was frustrating for us because we couldn’t solve their problem, even though we realized it was our patients that were contributing to the problem. But having this unit will move them into our space and will start the treatment.
The other thing it can do is that what could potentially be an inpatient admission could be diverted and the patient can be stabilized. Just to give you an idea, a patient comes in after a breakup with a girlfriend and is distraught, is suicidal, usually they end up in the hospital. If you have an empath unit where you can stay up to 72 hours, you help them regroup themselves and look at the big picture. The therapist will work with them in identifying coping skills and kind of help them pull themselves out of that moment of crisis and be able to reconnect them with the reality of the situation, so that they don’t become suicidal, and they could be reintegrated into the community. Your admissions-to-inpatient [ratio] will go down and they will be connected to the right level of service in the outpatient world.
Our goal is to divert them from the inpatient hospital stay, if we can. We have been open now for a few months at most of our EmPATH units, so we don’t have a huge amount of volume data to kind of make predictions on what impact we’re making on these patients, either positively or negatively. But I spoke to the University of Kentucky, and they have been running the EmPATH units for a year now, and they had 80% of the patients go back into the community, only 20% getting admitted. What we were seeing here in our hospital emergency department was 50% were getting admitted and 50% were going back into the community. So we’re hoping we’ll see a significant shift similar to what University of Kentucky is seeing now.
Q: What are the challenges?
LS: You need to have some amount of infrastructure in place for it to happen. You need to have the leadership buy-in for that concept. The one thing about the units that, as good as it sounds, it has been well validated across many areas. It hasn’t been scientifically validated well enough for it to be accepted as a gold standard, but I think it has a potential to be a good diversion unit for patients who are in a crisis. Now, there will be some patients who are actively violent, actively psychotic, and they are seeing significant demons. They may not be able to engage in EmPATH, but I’m hoping by separating those two emergency patients, you will be able to get a smaller portion toward inpatient and more toward the community.
You need to have a programmatic space within the emergency room. You need to have space for therapeutic activities like music, relaxation, group activities and group therapy itself. You need to make sure that you have a licensed counselor who could do that and coordinate all that. Then you need to have staffing for nursing and a provider, either a psychiatrist or a psychiatric nurse practitioner or someone to manage their medications when they are in the unit.
It does bring in some challenges of staffing and other things but it’s not, not doable. The good thing is that in the state of South Carolina, Medicaid does reimburse for that model. We can do all of these things, but if the payers don’t pay, then it’s not going to be a sustainable model five years from now. So having Medicaid wanting to support it is a critical aspect of making sure that this model continues to grow and sustain.
