A decade of early intervention for psychiatric patients in hospital emergency departments by a behavioral health intake team


Department of Psychiatry, Aurora Sinai Medical Center, Aurora Psychiatric Hospital, Aurora Research Institute

Presentation Notes

Presented at 2014 Aurora Scientific Day, Milwaukee, WI


Background: In the changing face of health care and the introduction of the Affordable Care Act, collaborative interventions are essential to compassionate and dynamic care. There is an increasing volume of patients with complex mental health and substance abuse treatment needs in emergency departments taking time away from medical teams. There is increasing recidivism among patients with complex mental illness, substance abuse and medical comorbidities. There has been increasing volume of uninsured patients needing interventions and resources from the expert Behavioral Health Intake Team (BHIT).

Purpose: Evaluate the role of a BHIT in six emergency departments (ED) in an integrated health care system in Wisconsin. Methods: Six hospitals in the Milwaukee area integrated this novel model of early access to care. Each BHIT has psychotherapists or nurses, who triage patients with behavioral health needs in collaboration with a psychiatrist. For all category variables, frequency count and percentages were computed, and chi-square test was used for testing the association between category variables such as age, disposition, types of insurance, time needed and the diagnoses. For statistical tests, an alpha level of 0.05 was used, and all statistical analysis was done using SAS 9.2 software (SAS Institute Inc., Cary, NC). Data was collected for patients assessed every year in ED since 2002. A 10-question survey was sent to emergency room staff to evaluate the role and the effectiveness of the BHIT.

Results:The BHIT in ED evaluated 45,161 patients from 2002 through 2013. Per survey results (N=96), 90% rated the effectiveness of the BHIT from very good to excellent; showed BHIT reduced their time spent with patients, provided expertise; reduced inappropriate admissions and established care plans to reduce recidivism in admissions. Majority of patients across all ages were mentally ill without comorbid substance use (P

Conclusion: The availability of a dedicated BHIT proved to be effective in improving the timely behavioral health access in emergency departments. Further research and exploration of available data will provide direction for improved patient care.

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