With 6 percent of all emergency room visits related to mental health issues and wait times for these patients ranging from eight to 24 hours, a dedicated psychiatric ER would appear to be the ideal solution. But as two emergency department veterans relate in Emergency Room Triage of the Mental Health Patient: Pilot Projects in Reducing ED Diversion, backup plans are sometimes necessary to manage the flow of behavioral health patients in the emergency room.

In this 35-page special report, Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center, part of Wishard Health Services in Indiana, describes how Midtown's dedicated seven-bed psychiatric ER initially was sufficient to handle patients presenting with mental health issues. But when regional developments caused patient demand to exceed the unit's capacity, further triage strategies were required.

Szempruch explains how the community mental health center's system-wide daily conference call helps to balance work and patient flow across 23 programs, encourages creative problem-solving and dramatically reduces staff time spent on diversion of psychiatric ER patients to other facilities from more than a week each month to just over a day.

Like Midtown, East Jefferson General Hospital in Louisiana had plans for a separate psychiatric ED. But when the ROI analysis for the non-profit community hospital's separate facility didn't hold up, the multidisciplinary team at the state's first magnet hospital went back to the drawing board. Plan B was the placement of a psychiatric nurse in Jefferson's emergency department. Joe Eppling, assistant vice president of post acute and behavioral health services at East Jefferson, describes the objectives of the pilot program, its impact on hospital admits, discharges and resource allocation, and its effect on ED staff satisfaction and morale.

East Jefferson was one of only three facilities that remained open during and after Hurricane Katrina, and Eppling assesses the impact of the post-Katrina environment on inpatient bed availability, ER patient volumes and the extent of the mental health crisis among the region's uninsured population.

In addition, these two emergency room veterans answer a host of questions on the topic and provide additional details on:

• Identifying barriers to care of psychiatric patients;
• Reducing time spent on diversion of mental health patients;
• Improving care transitions of psychiatric patients requiring inpatient admission;
• Evaluating the financial case for a dedicated psychiatric ER;
• Reducing inappropriate psychiatric admissions through the ER;
• Improving satisfaction of ER staff;
• Adhering to EMTALA regulations regarding the handling of psychiatric patients;
• Assuring that the uninsured receive equal access to medical and mental health resources;
• Using medical homes and retail clinics as alternative non-emergency resources for mental health issues;
• Establishing linkages with community behavioral health providers;
• Handling high users of ER services, a.k.a. "frequent flyers";
• Incentivizing PCPs and hospitals for proper ER utilization;