According to data from a 2017 National Youth Risk Behavior Survey, 20% of all high school students have seriously contemplated attempting suicide over a 10-month period. Often, these kids present to the emergency department (ED), a trend Dayton Children’s Hospital’s ED was witnessing. The hospital was seeing more in the ED with thoughts of self-harm or suicide ideation.
“When you have a kid coming in that is suicidal, the ED is not the best place for them,” says Kelly Blankenship, D.O., chief medical program director, Inpatient Behavioral Health Unit and Crisis Services at Dayton Children’s Hospital in Ohio. “The sharps, tubing and wires…you have to have someone with them on a one-to-one basis to prevent the risk of the patient hurting themselves, which costs the hospital a lot of money, and at times, doesn’t always prevent the patient from causing harm.”
At the 2019 Annual Leadership Conference, Blankenship and her colleague, Mindy Schultz, M.S.W., LISW-S, manager, Behavioral Health Crisis Services at Dayton Children’s, discussed that the hospital saw a need for a different way of caring for these patients and how the organization implemented the idea of a behavioral health crisis center. Today, the hospital provides these services in an outpatient setting, with a separate lobby and entrance to help families identify the location.
Families walk into the Behavioral Health Crisis Center, or they can still go through main ED, where providers screen the patient, ask if they hurt themselves that day or have another injury they need to see a doctor for. At the crisis center, patients and families are informed they are constantly monitored via video, educated about the safety features in the space, and staff lock up patients’ and families’ cell phones and personal belongings. They are also presented with an iPad loaded with a video that explains the crisis center and what’s next for them during their visit.
The center is structured as a Type B ED, which allows mental health professionals to treat patients who do not need medical care. Staff determine if the patient needs inpatient treatment, and if needed, transfers patients in the electronic medical record (EMR) to the ED as a patient, which assigns a physician or nurse. The provider then comes to the crisis center for the exam, imaging or any lab work that may be needed. “This has been a great satisfier for our families,” says Schultz. “We don’t have to relocate them into the main ED and take up a room for other patients who are waiting.”
As a result of these efforts, the hospital:
- Decreased family waiting time from 3.5 hours to 2.5 hours from arrival to discharge.
- Decreased charges to the family by about $1,000 if the patient is discharged without seeing a doctor.
- Decreased staffing costs.
- Improved follow-up care after discharge; Mental Health Resource Connection team members call families to provide follow up for mental health therapy appointments.
While the crisis center is seeing some positive results, Blankenship says the team will continue to look for ways to streamline staffing models to better respond to seasonal variability and help families improve follow-up appointment adherence.
