Hospital expands to meet needs
An increase in behavioral health patients staying more than 24 hours in Mid Coast Hospital’s emergency room has prompted the company to expand in two ways.
The hospital in Brunswick, Maine, is paying $740,000 to add three urgent care bays off its waiting room and a secure behavioral health observation unit to its emergency department.
“We’ve seen a 91 percent increase (between 2010-2014) in the care hours that we spend,” says Thomas Kivler, LCPC, CCS, director of the behavioral health division at Mid Coast. “About 25 percent of our care hours given are to behavioral health, even though that’s only a smaller amount of our overall volume, more like 8-9 percent.”
Specifically, in 2010, the hospital saw about 64 behavioral health patients per month. The average is now about 158 a month. In 2011, the average length of stay for patients dealing with mental illnesses was 7.7 hours. That average is now 11 hours, says Kivler.
“There is nobody who is saying they know the cause of this that I am aware of,” he says. “I think people are wondering about the impact of the economy and they are wondering about decreases in funding for community mental health programs.”
Kivler says a lack of hospital beds state-wide for patients dealing with acute mental illnesses has increased emergency room stays. “There has been more need for security, more need for restraint, certainly a lot more training for staff in those regards,” he says. “Emergency rooms are not a great place for people who are struggling emotionally and psychologically.”
Space adjacent to the emergency department is being renovated for a new behavioral health observation unit. “This is a large area that is secure, has behavioral health trained staff, three rooms as well as a common area, comfortable furniture, natural light as well as the nurses’ station,” he says.
A psychiatric consultation will be ordered at six hours into a patient’s stay in the unit. “The goal is to start treatment as soon as possible,” says Kivler.
A patient and family advisory panel has been meeting over the past year to help design the unit. That panel includes a representative from the National Alliance on Mental Illness, or NAMI, local nonprofit Sweetbread, behavioral health peers and others, he says.
Staff in the unit will undergo behavioral health training that has been developed with NAMI. The unit should be completed in March 2015.
Construction has started on three urgent care bays off the hospital’s emergency room waiting area. Called “quick care spaces,” rooms have chairs rather than beds and are meant to be used when there is a surge of patients waiting to be seen. “It’s really designed to triage out the lesser critical folks and get them into treatment and out the door as quickly as possible,” says Kivler.
These spaces can be used for behavioral health patients, but use is open to all patients needing urgent care. “Usually the average time most people spend in the emergency room is two hours,” says Kivler. “With behavioral health, they can stay for many, many days. The impact is that people with other issues end up waiting. This will allow us to triage people and if they just need some quick care, we can do that more readily.”
Construction was expected to wrap in December 2014, he says.