Tag Archive for: Beds

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XFERALL Behavioral Health Collaborative Approach and 988 Crisis

For decades, it has been commonly understood that individuals experiencing a medical emergency shouldn’t wait for treatment. Treatment guidelines for individuals experiencing heart attacks, strokes and traumatic injuries prioritize rapid response. The medical community refers to the “golden hour” — the 60 minutes within which an injured or sick person should receive definitive treatment from the time of injury or onset of symptoms. If care is delayed beyond this hour, the risk of serious, long-term complications or death significantly increases. New systems of care, often regionalized, emerged to ensure that no precious time is lost in transporting, stabilizing, treating, and transferring patients.

Yet, for people experiencing a psychiatric or substance use emergency, a similar urgency coupled with system change hasn’t prevailed. Even in 2022, too many hospitals, crisis teams, first responders, and others needing to get people into behavioral health treatment quickly must rely on outdated, manual processes to locate clinically appropriate care, which cause critical delays in care. In their search for placement, clinicians are calling behavioral health facilities and programs one-by-one, leaving messages, faxing paperwork, and waiting for calls to be returned. The seemingly simple act of transferring a patient to behavioral health care is requiring clinicians to spend countless hours on repetitive administrative tasks that take them away from direct patient care.

The result is that, far too often, children, adolescents, and adults experiencing a behavioral health crisis wait hours or even days for placement in clinically appropriate therapeutic treatment. One study documents an average length of stay in the hospital emergency department for psychiatric admissions of 18 hours, compared to 5 hours for non-psychiatric admissions.1 Others have estimated average boarding times of between 6.8 hours and 34 hours for patients needing psychiatric treatment.2,3

Today, these wait times are likely even longer as the pandemic has made the ED boarding crisis worse in two ways. One, hospitals are at or beyond capacity with patients with COVID-19 and other serious physical conditions coupled with ever increasing staffing shortages. Two, the pandemic, and the associated anxiety, stress, and isolation, have contributed to an increased need for behavioral health care, particularly among children and adolescents. Children’s hospitals reportedly saw a 45 percent increase in pediatric self-injury and suicide cases between January and July 2021.4 In 2020, pediatric mental health-related hospital emergency department visits increased 24 percent for children ages 5-11 and 31 percent for older children and adolescents.5

XFERALL’s mission is to drastically save time for clinical staff and reduce the amount of time patients spend in EDs waiting for a transfer to the most appropriate care center by applying innovative technology solutions. The platform enables real- time communication so that clinicians needing to place a patient can request placement at as few or as many facilities as they choose; receive responses from facilities or programs that can accept and treat the patient; and share clinical information — all within minutes and within a single source. This coordinated approach allows caregivers and patients to be engaged in the decision-making process as well.

The District of Columbia Hospital Association and XFERALL, the nation’s leading mobile patient transfer platform, have entered a partnership that offers DC hospitals a new process for transferring acute and behavioral health patients to clinically appropriate health care facilities. To learn more, join us on May 10 for a free webinar, Behavioral Health Patient Transfer & Placement Technology, and learn about this program and how it can support improving access for patients in crisis.

XFERRAL Webinar Graphic

1 Nicks BA, Manthey DM. The impact of psychiatric patient boarding in emergency departments. Emerg Med Int 2012; 2012: 360308.

2 Weiss AP, Chang G, Rauch SL, et al. Patient and practice-related determinants of emergency department length of stay for patients with psychiatric illness. Ann Emerg Med. 2012;60(2):162–71.

3 Tuttle GA. Access to psychiatric beds and impact on emergency medicine. Chicago, IL: Council on Medical Service, American Medical Association; 2008.

4 Pediatricians, Child and Adolescent Psychiatrists and Children’s Hospitals Declare National Emergency in Children’s Mental Health, October 19, 2021.

aacap.org/aacap/zLatest_News/Pediatricians_CAPs_Childrens_Hospitals_Declare_National_Emergency_Childrens_ Mental_Health

5 Ibid

Tag Archive for: Beds

November 2022 Utilization Report

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Utilization Report - November 2022.pdf

Highlights
All utilization metrics remained consistent from last month to the current month reported compared to pre-COVID baselines. There was a slight decrease in psychiatric admissions volumes volume going from -24% in October 2022 to -25% below baseline in November 2022. The same pattern was noted for emergency department admissions volumes which moved from -21% in October to -22% in November. While acute care admissions remained steady at -17% below baseline, observations admissions were the only metric that showed a steeper drop going from 9% above baseline last month to -9% below it.

October 2022 Utilization Report

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Utilization Report - October 2022.pdf

Highlights: There was a noted increase across all utilization metrics this month compared to pre-COVID baselines: psychiatric admissions have the biggest increase in volume going from -31% to -24% below January 2020 baseline. Emergency department visits slightly increased going from -24% last month to -21% below pre-COVID, and ambulatory surgery changed from -12% to -8% (Fig.1). Although October 2022 observation visits remained above the January 2020 pre-COVID baseline for the third month in a row with volume 9% greater than the baseline month, the volume was below both October 2020 and October 2021 by -7% and -4% respectively.

September 2022 Utilization Report

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Utilization Report - September 2022_.pdf

Looking at utilization metrics, there are slight fluctuations in volumes across all measures. Emergency department visits slightly increased going from -25% last month to -24% below pre-COVID baselines while acute care admissions on the other hand saw a minor decrease this month, going from -13% in August to -19% below baselines. Psychiatric and observation admissions also show a little variation from last month to the current month (Fig. 1). Newborn admissions show a decrease this month with the lowest volume observed since May 2022 after last month’s spike. See Table 11 of the report for details.

August 2022 Utilization Report

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Utilization Report - August 2022_.pdf

Highlights: Looking at utilization metrics, all measures show an increase in volumes this month. Emergency department visits went from -27% last month to -25%this  month below pre-COVID baselines. The biggest increase in volumes was for ambulatory surgeries going from -21% to -4% below baselines (see Fig. 1). Moreover, there is an increase in newborn admissions, the highest volume in the last 15 months as depicted in Table 11 of the report.

July 2022 Utilization Report

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Utilization Report - July 2022.pdf

Highlights: Looking at utilization metrics, all four measures tracked in Fig. 1, except acute care admissions, show a decrease in volumes for the month. Emergency department visits went from -19% last month to -27% below pre-COVID baselines in July. Ambulatory surgeries and psychiatric admissions follow the same pattern going from -6% to -21% and -28% to -32% below baselines respectively (see Fig. 1). Moreover, all five birthing hospitals saw an increase in newborn admissions for July with the highest cumulative number of admissions since December 2021 as reported in Table 11 of the report.

June 2022 Utilization Report

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Utilization Report - June 2022.pdf

Hospitals submitting June data showed a slight increase in emergency department visits this month going from -28% last month to -27% in June compared to pre-COVID baselines*. Acute care admissions, psychiatric admissions and ambulatory care surgeries on the other hand showed minor decreases in volumes. These are reflected in the percent change graphs displayed in Figure 1 below. Two of the hospitals reporting psychiatric admissions saw their lowest volumes over the 15-month period ending June 2022. See Table 7 of the report for details.

© 2023. District of Columbia Hospital Association.