IOWA CITY — Inpatient units for adults across the University of Iowa Hospitals and Clinics campus are packed — regularly reporting over 90 percent occupancy, stalling patients who would be or should be admitted in an often full emergency room.
Contributing to the congestion in the ER are mental health patients, with 10 or 12 coming to the emergency department daily, said Jodi Tate, UIHC vice chair for clinical services in psychiatry.
“People with mental illness are essentially boarding in the emergency rooms because of a lack of community services,” Tate said, noting UIHC is hardly alone in battling what has become a nationwide mental health crisis.
“They are hanging out there for days waiting for a patient bed with very little intervention,” Tate said. “It’s pretty awful.”
In search of a better model — one that frees space in the hospital while providing better care — UIHC connected with Scott Zeller, vice president of acute psychiatric medicine at CEP America, a company that looks at ways to improve efficiency, patient satisfaction and medical outcomes.
Zeller, former chief of psychiatric emergency services for the Alameda Health System in Oakland, Calif., is architect of a relatively new model for patients that uses an “emergency psychiatric assessment, treatment, and healing unit” to provide empathetic rather than coercive care.
About 30 U.S. locations have tapped the model, and Zeller visited UIHC in September 2017 to consult on its new “crisis stabilization unit.”
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That unit, which began seeing patients Monday, combines a “calm, comfortable, and inviting space” with high staff-to-patient ratios.
“This model of care is meant to improve patient outcomes,” Tate said. “It’s also meant to decrease admission rates.”
With the new unit in play, patients who arrive in the ER with a mental health concern will be evaluated, checked for medical issues and transferred to the stabilization space, where professionals will craft a treatment plan that could include medication, therapy and referral to community resources.
In a calmly-lit room with an open layout that includes several private spaces, reclining chairs, a place to get clean and storage for belongings, patients will have — ideally — 20 to 24 hours to either stabilize and head home or find a bed in the hospital or with a community partner.
Patients will have the opportunity to interact, to get food, to rest with a warm blanket or just watch TV.
“It used to be when people came to the emergency department, there were two choices — you either admit or you discharge, and that decision was made right then,” Tate said. “With this model of care, people are evaluated and if they can go home, they can go home.” If not, the hospital will admit them.
“Our hope is we will free up beds for folks who really need beds,” she said.
Other similar stabilization units across the country have decreased patient admission rates about 25 percent, according to Tate.
The new UI unit has capacity for 12 adults. The aim is to have no more than a four patients-to-one staff ratio, with nurses, physician assistants, doctors and social workers staffing the space — along with a plain-clothed security officer trained specifically in psychiatric care.
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The project cost $1.1 million and took about a year to construct in the space that housed a neonatal intensive care unit. That unit moved after the UI Stead Family Children’s Hospital opened.
Johnson County — in a similar vein — is working toward opening a Behavioral Health Urgent Care Center that would give police a place to take people in crisis, other than to jail or to the emergency room.
The county recently agreed to pay $1.35 million for 5.34 acres of land at 270 Southgate Ave. for the new center.
Tate said although their missions are aligned, the UIHC unit is separate from the Johnson County initiative.
“People, I think, are finally realizing we need to do something,” she said. “This is bad.”
Heidi Robinson, a nurse manager staffing the new stabilization unit, has been working with mental illness for years and believes this unit will save hospital resources not only immediately, but in the long term as well.
“This provides us an opportunity to get them treatment right away, to get them medication right away, and then to really work with the people in the community to get them follow up and get them the resources they need so they don’t need to keep coming back to the emergency room in crisis.”
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