Beating the Behavioral Health Boarding Blues: Decreasing Emergency Department Boarding Time

Purpose:
As the behavioral health crisis impacted our Emergency Department (ED), an approach was needed to the reduce the number of ED behavioral health boarding hours and improve care and services to this population. A goal to decrease monthly boarding hours to below 743 hours was set.

Relevance/Significance:
Our total number of behavioral boarding hours in November 2013 averaged 1088 hours per month. The high prevalence of mental health issues within our state created challenges with access. Many patients present to the ED versus a behavioral health setting. These patients were identified by the organization as a population at risk. When beds in the community are unavailable, they board in the ED until placement is found. This nurse driven solution demonstrates holistic view of the care environment.

Strategy and Implementation:
The behavioral health populations pose particular challenges to emergency care providers. Boarding hours impacts ED flow, resource and bed availability. To address the problem of improving care and access, an innovative, collaborative approach was taken. Sustainable changes included daily rounding, pharmacy and dietary support, standardized behavioral health order sets and guidelines which included activities of daily living, home medication management, chronic disease management and consults. Our system partnered with community behavioral health organizations and system affiliates with inpatient resources. A steering group was formed and increasing behavioral health access was made an organizational priority. Affiliate work targeted underutilized affiliate capacity, inadequate communication, consult availability and transfer processes. Aligned with these efforts, ED leaders met with the state's largest behavioral health center to smooth transitions and advocate for access.

Evaluation:
A multifaceted approach utilizing organizational and community collaborations successfully decreased behavioral health boarding hours. ED nurses, ED physicians, and psychiatry consultants worked together to improve care. The ED successfully met the goal to decrease behavioral health boarding hours reducing to an average of 653 hours per month as of November 2014, meeting the target of 743 hours.

Implications for Practice:
There is a behavioral crisis which affects ED's. With ED nurses at the bedside advocating for improved care, ED leadership partnering with organizational affiliates and coordinating with behavioral health centers, innovative ideas can flow and boarding hours can be decreased.