Innovative approach to behavioral health reduces stays in emergency departments

Despite an increase in patient visits, Sentara’s innovative approach to behavioral healthcare reduced stays in the emergency department during 2023.

Sentara lowered the emergency department length of stay for patients with behavioral health needs by 10.4% last year, although patient visits increased 18% during the year.

The efforts come against the backdrop of a nationwide crisis in behavioral health, a term that includes mental health and substance use disorders.

One in five adults has received recent mental health treatment, while more than 130 people die daily from opioid-related overdoses. A recent White House report spotlighted the mental health crisis, reading, “Our nation is facing a mental health crisis among people of all ages, and the COVID-19 pandemic has only made these problems worse.”

‘We knew we had to change things to serve our community’

Sentara began seeing more patients with behavioral health needs during the pandemic, when staff shortages became increasingly common, said Ken Dunham, M.D., executive director of medical operations for behavioral health at Sentara. Many of these patients ended up at the emergency department.

“As a non-profit safety net institution, Sentara knew we had to change things to serve our community,” said Dr. Dunham.

“We looked at how we were handling patients that came to our emergency departments across the system. We wanted to find efficiencies and best practices that would help our patients get to the right level of service at the right time. This meant paying special attention to our emergency department patients with behavioral health issues.”

A multi-disciplinary team of experts made four key changes across Sentara’s system. They:

1. Created a centralized assessment team of therapists and specialized staff with the option for both virtual and in-person evaluations.
2. Increased psychiatric physician help, including through an expanded partnership with a telepsychiatry vendor.
3. Launched an evidence-based program to stratify patient risk, with screening processes for suicide.
4. Developed a network of experts, resources, and community providers to help discharged patients obtain prompt follow-up appointments

Sentara wanted to ensure timely access to care, including an evaluation by a psychiatrist or therapist, said Nedra Moncrief-Craig, director of behavioral health services.

“The changes have reduced the patient wait time in the emergency department and decreased the exacerbation of behavioral health symptoms,” said Moncrief-Craig.

Supporting a patient with behavioral health needs

Cassie Bozard is a behavioral health navigator at Sentara Leigh Hospital and one of the experts who helps patients obtain follow-up care. Her position was created in November of 2022 as part of Sentara’s revamped approach to behavioral health. She educates patients on mental illness, connects them to resources, and works with them to develop outpatient treatment plans.

Bozard recently helped a homeless patient who had arrived at the emergency department with mental health and substance-abuse issues. Because of the flexibility of her position, she was able to meet with him for an hour-and-a-half. They talked about his concerns, and she learned he was trying to find his mother.

“I was able to get in touch with his brother, get his mom’s number, and reconnect them,” she said. His mother was willing to take him in, she learned. After finding temporary housing for the patient, she reached out to a charity organization to get him a bus ticket to Florida, where his mother lives.

By the end of their meeting, the patient already seemed like he was doing better. “You could tell he was just in a better place,” said Bozard. “He even looked different.”

Addressing gaps in opioid treatment

The new approach includes the Sentara Opioid Bridge to Recovery program, which standardizes processes for treatment and follow-up. As part of the program, medical staff administer buprenorphine, a drug that eases withdrawal and blocks the ability of opioids to cause euphoria.

The program ensures patients leave the emergency department with an appointment for follow-up care, said Carol McCammon, M.D., an emergency medicine physician.

“You can treat the patient with medication in the emergency department,” Dr. McCammon said. “But if they don’t have anywhere to go, they’re not going to be able to continue treatment.”

Although Dr. McCammon called opioid use an “exceedingly difficult problem,” she is optimistic about the new approach to treatment.

“If we continue to address this from a scientific standpoint and a humanistic standpoint, we can definitely start to move the needle.”

Putting more resources toward the problem

According to Eleanor Erwin, M.D., an emergency medicine physician, the new behavioral health processes streamline communication and make care more efficient. They also help ensure timely follow-up, which is one of the biggest challenges providers face when treating patients with behavioral health needs.

“I’m very excited by the resources Sentara has started to put toward this problem, and I think we have really done a great job with some brutally complicated patients,” said Dr. Erwin. “I think it’s made a difference in the community.”

You can learn more about Sentara’s behavioral health services here.