Assessment & Transfer of MI Pts From EDs to St Hospitals
Excerpt from 5/22/08 Illinois Hospital Association memo
Illinois hospital emergency departments (ED) have served a large and growing number of patients with mental illnesses in recent years, paralleling national trends. A recent IHA survey indicated an almost 50% increase in ED presentations between 2002 and 2004 of patients with mental illnesses; a 2005 national survey of EDs indicated a 60% increase. Persons with mental illnesses seek care in the ED primarily because other appropriate alternatives are unavailable or unaffordable; and there are too few acute care facilities to meet demand. As a consequence, many patients with mental illness wait a long time for an acute care bed to become available, twice as long as other medical patients according to the IHA survey. And, if the patient was going to be transferred to a state-operated hospital (SOH), they have waited an average of 15 hours in one urban hospital (a time period reported by many hospitals); other hospitals reported patients waiting as long as 20 or 30 hours for transfer. Once in an ambulance, these same patients were waiting, at times, several hours in the parking lots of the SOHs for admission. The risks to patient safety warranted immediate attention.
Facilitated by both the Illinois Hospital Association and the Illinois Division of Mental Health, an interdisciplinary task force of health care professionals convened initially in October 2006 and thereafter for two years to address not only the immediate problem of reducing wait times in ambulances, but also the need to look at the systems in which the patients were evaluated, assessed for transfer to a SOH, transported to the SOH, and admitted to the SOH. Representing the Illinois College of Emergency Physicians (ICEP), the Metropolitan Chicago Healthcare Council, community mental health centers, ambulances, and the Division of Mental Health, they joined forces to create a patient-centered environment in which the patient experienced a respectful as well as a clinically appropriate process.
