Minority-Owned Business Enterprises: Transforming Health Care And Advancing Health Equity

Equity is defined as the absence of systemic disparities between groups with different levels of underlying social advantage/disadvantage—wealth, power or prestige. From voter suppression to housing discrimination, racial differences in health outcomes can be explained by centuries of policies and practices that have intentionally excluded nonwhite groups from access to opportunity. Moreover, inequitable practices baked into the “institutions” that shape society sustain seemingly intractable disparities in health.

The institutions of medicine and health care are no exceptions. But as discussed below, many minority-owned business enterprises (MBEs) are challenging the status quo in health and health care, advancing health equity in transformative ways, and bridging the gap between health care and the many social factors that occur outside of care settings but have a huge impact on health.

Authors: Dr. Christopher King, Dean of School of Health, Georgetown University Medical Center and Deliya Banda Wesley, Senior Director of Health Equity, Mathematica

The Cost of the Status Quo: The Consequences of Prolonged Emergency Department Boarding

Op-ed written by Shana Palmieri, LCSW, Chief Clinical Officer and Cofounder, XFERALL

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The Washington Post recently published the article ‘An autistic teen needed mental health help. He spent weeks in an ER instead.’ It is beyond distressing to hear repeated stories about the suffering of patients and families like Zach’s, spending days and in this case months in the emergency department waiting for a transition to behavioral health treatment.

As health care providers and administrators, you have likely faced the challenge to ensure timely access to behavioral health services for patients like Zach experiencing a crisis. The health care team working around the clock to facilitate better referrals and placement for clinically appropriate care to meet their needs. Often this is met with challenges, outdated processes and limited options to which this article provides an insight to.  These stressful situations impact everyone involved, the patient, the family, caregivers, and the entire care team.

Speaking from my own experience, many of us have walked into our emergency departments with patients lined up on stretchers needing behavioral health crisis services waiting for hours and days for placement. The challenge is nationwide, with patients languishing in the emergency department causing a myriad of operational and quality of care challenges. Meanwhile the  consequences of emergency department boarding of psychiatric patients present increased risk often leading to negative outcomes that are distressing, traumatic, or potentially life-threatening. The consequences of maintaining the status quo without a systemic intervention to drive improvements spreads across multiples domains.

Quality Patient Care, Safety & Risk Management 

Psychiatric patients boarding in the emergency department increases risk events for the patient themselves, health care professionals and other patients presenting to the emergency department for acute medical conditions. As emergency departments reach their capacity limits, staff are stretched thin sometimes resulting in increased risk events. Quality of care is impacted for all patients because of obstacles to efficient throughput. The entire health care system can become bottlenecked, patient care suffers and at times safety is compromised.

Workforce Inefficiencies and Shortages

The health care industry is amid a critical health care workforce shortage. According to the 2022 NSI National Healthcare Retention & RN Staffing Report, the average hospital turnover rate is now 25.9% – an increase of 6.5%.

During this challenging workforce shortage, highly trained healthcare professionals have to follow manual processes to coordinate care by making repeated phone calls and faxing to find an available behavioral health placement, while delays and patient care is waiting. Hours and hours of precious staff time is wasted on an inefficient process when the opportunity to use resources to automate and improve productivity drastically reducing emergency boarding times is available.

Lost Opportunity and Cost 

The cost of psychiatric emergency department boarding to health system’s is significant. Delayed care leads to poor outcomes and emotional stress felt by staff and patients. Additionally there are financial implications when these scenarios become the norm. Health systems may have to limit their ability to treat and admit higher acuity medical patients. This right sizing for facilities is critical to ensure all services can continue to be provided for communities.

Extended behavioral health boarding costs occur when clinicians are searching for bed placement, for example a mid-sized acute-care hospital were transferring on average 90 behavioral health patients a month. This process took on average over 8 hours per patient to find an appropriate transfer for a bed placement That equated to over 720 hours per month just in staff time to find placement. At the estimated cost of $250 an hour to board a behavioral health patient in the emergency department (includes cost of care and opportunity lost) those 720 hours is equal to a loss of $180,000 per month or $2,160,000 per year. This hospital automated the bed placement process and today their average time to find a bed is under 55 minutes. With these changes the same 90 patients now cost the system only $22,500 per month or $270,000 per year.  That is a cost savings of $1,890,000 annually.

Changing the Status Quo 

The cost of maintaining the status quo is significant. Change is hard. We consistently ask our patients to make significant, difficult, life transforming changes to improve their health, improve their mental health symptoms and eliminate their addictions. Healthcare systems, clinicians and administrators also must engage in this type of proactive change to reap the positive benefits in the years to come.  The cost is too high to keep things the way they are for patients, for families, for health care providers and for the health care system.

A Behavioral Health Automated Transfer Network is available in the District of Columbia and surrounding states.  The automated network offered through XFERALL, a web-based platform with companion mobile application, is available to healthcare systems, first responders, mobile crisis teams and local crisis providers. Working together, standing up an  network, expediting transfers, and using real-time data to drive continuous quality improvement will lead us one day at a time away from the challenges, excess cost, and negative patient and healthcare provider experience and into a future that drives consistent improvements in quality patient care, decreases risk events, improves safety, provides transparent data to enhance regional capacity, addresses staff safety, and improves access to care that ensure patients and families similar to Zach’s have immediate access to quality care.

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Abordagem Colaborativa de Saúde Comportamental XFERALL e Crise 988

Por décadas, tem sido comumente entendido que os indivíduos que passam por uma emergência médica não devem esperar pelo tratamento. As diretrizes de tratamento para indivíduos que sofrem ataques cardíacos, derrames e lesões traumáticas priorizam a resposta rápida. A comunidade médica se refere à “hora de ouro” – os 60 minutos em que uma pessoa ferida ou doente deve receber tratamento definitivo a partir do momento da lesão ou início dos sintomas. Se o atendimento for atrasado além dessa hora, o risco de complicações graves e de longo prazo ou morte aumenta significativamente. Novos sistemas de atendimento, muitas vezes regionalizados, surgiram para garantir que nenhum tempo precioso seja perdido no transporte, estabilização, tratamento e transferência de pacientes.

No entanto, para pessoas que passam por uma emergência psiquiátrica ou de uso de substâncias, uma urgência semelhante associada à mudança do sistema não prevaleceu. Mesmo em 2022, muitos hospitais, equipes de crise, socorristas e outros que precisam levar as pessoas a tratamento de saúde comportamental rapidamente devem contar com processos manuais desatualizados para localizar atendimento clinicamente adequado, o que causa atrasos críticos no atendimento. Em sua busca por colocação, os médicos estão ligando para as instalações e programas de saúde comportamental um a um, deixando mensagens, enviando documentos por fax e aguardando o retorno das ligações. O ato aparentemente simples de transferir um paciente para cuidados de saúde comportamental está exigindo que os médicos gastem inúmeras horas em tarefas administrativas repetitivas que os afastam do atendimento direto ao paciente.

O resultado é que, com demasiada frequência, crianças, adolescentes e adultos que passam por uma crise de saúde comportamental esperam horas ou mesmo dias para serem colocados em tratamento terapêutico clinicamente adequado. Um estudo documenta um tempo médio de permanência no pronto-socorro hospitalar para internações psiquiátricas de 18 horas, em comparação com 5 horas para internações não psiquiátricas.1 Outros estimaram tempos médios de internação entre 6,8 horas e 34 horas para pacientes que necessitam de tratamento psiquiátrico. 2,3

Hoje, esses tempos de espera provavelmente são ainda maiores, pois a pandemia piorou a crise de embarque do ED de duas maneiras. Primeiro, os hospitais estão no limite ou além da capacidade com pacientes com COVID-19 e outras condições físicas graves, juntamente com a crescente escassez de pessoal. Dois, a pandemia e a ansiedade, estresse e isolamento associados contribuíram para uma maior necessidade de cuidados de saúde comportamental, principalmente entre crianças e adolescentes. Hospitais infantis relataram um aumento de 45% nos casos de automutilação e suicídio pediátricos entre janeiro e julho de 2021.4 .5

A missão da XFERALL é economizar drasticamente o tempo da equipe clínica e reduzir a quantidade de tempo que os pacientes passam em EDs esperando por uma transferência para o centro de atendimento mais adequado, aplicando soluções tecnológicas inovadoras. A plataforma permite a comunicação em tempo real para que os médicos que precisam colocar um paciente possam solicitar a colocação em quantas instalações quiserem; receber respostas de instalações ou programas que podem aceitar e tratar o paciente; e compartilhe informações clínicas — tudo em minutos e em uma única fonte. Essa abordagem coordenada permite que cuidadores e pacientes também se envolvam no processo de tomada de decisão.

A Associação de Hospitais do Distrito de Columbia e a XFERALL, a principal plataforma móvel de transferência de pacientes do país, firmaram uma parceria que oferece aos hospitais de DC um novo processo de transferência de pacientes de saúde aguda e comportamental para unidades de saúde clinicamente apropriadas. Para saber mais, junte-se a nós em 10 de maio para um webinar gratuito, Tecnologia de Transferência e Colocação de Pacientes de Saúde Comportamental, e saiba mais sobre este programa e como ele pode ajudar a melhorar o acesso de pacientes em crise.

XFERRAL Webinar Graphic

1 Nicks BA, Manthey DM. O impacto da internação de pacientes psiquiátricos em serviços de emergência. Emerg Med Int 2012; 2012: 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Determinantes relacionados ao paciente e à prática do tempo de permanência no departamento de emergência para pacientes com doença psiquiátrica. Ann Emerg Med. 2012;60(2):162–71.

3 Tuttle GA. Acesso a leitos psiquiátricos e impacto na medicina de emergência. Chicago, IL: Conselho de Serviço Médico, Associação Médica Americana; 2008.

4 Pediatras, Psiquiatras Infantis e Adolescentes e Hospitais Infantis Declaram Emergência Nacional em Saúde Mental Infantil, 19 de outubro de 2021.

aacap.org/aacap/zLatest_News/Pediatricians_CAPs_Childrens_Hospitals_Declare_National_Emergency_Childrens_ Mental_Health

5 Ibid

ONE-DC: Quem somos

ONE DC é uma organização sem fins lucrativos composta por enfermeiros líderes e enfermeiros que aspiram a ser líderes. Isso inclui enfermeiros de todas as configurações e especialidades, que ocupam cargos como executivos de enfermagem, administradores, gerentes de enfermagem, educadores de enfermagem, gerentes de qualidade de enfermagem, líderes de equipe de enfermagem e pesquisadores de todo o Distrito de Columbia. A organização aborda a força de trabalho de enfermagem, administração, educação, prática baseada em evidências, pesquisa, política de saúde e questões de prática profissional.

ONE Oficiais de DC:

Laura Hendricks-Jackson - Presidente interina / Tesoureira
CNO, Hospital Memorial Sibley

Hazel Darisse – Secretária
Assistente CNO, Hospital Universitário George Washington

April is National Donate Life Month

April is National Donate Life Month, a time to encourage people to register as organ, eye and tissue donors and to celebrate those that have saved lives through the gift of donation.

Across the U.S., there are more than 112,000 patients on the national transplant waiting list who need a kidney, heart, lungs, pancreas, liver, or intestine. Thousands more need tissues such as corneas to restore sight, skin to heal burns, heart valves to repair defects, bones to correct injuries and tendons/ligaments to restore movement.

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       Malkia White

Currently, there are more than 2,200 patients in the D.C. metropolitan area waiting for a lifesaving transplant. Patients like Malkia White who was diagnosed with kidney disease when she was a young girl. She successfully managed her disease most of her life, until a few years ago, when her kidney function went into rapid decline. Malkia, who is now on the waiting list for a new kidney, relies on dialysis treatment three nights a week to keep her alive.

Washington Regional Transplant Community (WRTC), the local non-profit organ procurement organization responsible for facilitating donation process, has a longstanding relationship with hospitals in D.C. Thanks to its hospital partners, WRTC recovered and allocated 485 lifesaving organs from 145 generous donors in 2019, saving the lives of 417 individuals. In addition, WRTC also recovered tissues from 462 benevolent donors, whose precious gifts could enhance the lives of nearly 35,000 people.

Be part of the miracle. During National Donate Life Month, give people like Malkia hope by registering to be an organ, eye and tissue donor at BeADonor.org.

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© 2024. District of Columbia Hospital Association.