2024 15th Annual NUBE Conference

Emergency departments have experienced a significant increase in visits from patients with behavioral health emergencies over the years. Unfortunately, this rise has not been accompanied by adequate national, regional, or state-level responses in acute care delivery, treatment development, care standards, or agreed-upon treatment goals and metrics. Consequently, millions of patients, both adults and children, spend extended periods in emergency departments each year without receiving proper treatment. This gap between the growing needs of these patients and the lack of a coordinated national response has prompted the development of numerous local solutions. These innovative approaches aim to transition from the traditional stabilization-boarding-disposition sequence to a treatment philosophy that views boarding time as an opportunity for active treatment and clinical improvement.

A key aspect of this new approach is the emphasis on understanding both patients' and healthcare workers' perspectives. Recognizing patients' experiences, wishes, and goals is essential for providing patient-centered care that is more holistic and therapeutic. Equally important is understanding the perceptions of healthcare workers who deliver care to boarding behavioral health patients. This dual perspective is novel and critical for developing effective and meaningful care strategies in emergency departments.

In this presentation, a panel consisting of a patient advocate and an expert in emergency medicine and behavioral health emergencies will describe the concordant and contrasting experiences of ED boarding, as well as the therapeutic goals envisioned and perceived by patients and healthcare workers. The presenters conducted semi-structured interviews with patients currently boarding for behavioral emergency care and with healthcare workers who provide care to these boarding patients in the same urban ED. Thematic analysis was performed to identify commonalities and disparities in the perspectives of the two groups. Based on these findings, the presenters developed a supportive, healing environment for ED behavioral health patients, focusing on interdisciplinary care with empathy and trauma-informed approaches to acute stabilization, treatment, and reassessment of both medical and psychiatric illnesses. The panelists will draw from their research, clinical experience, and programmatic expertise to discuss the design and implementation of interdisciplinary ED-based interventions informed by patient and healthcare worker perspectives and experiences, and share their learnings on what works and does not work in this novel clinical setting.

Learning Objectives:

Understand the Gap in Behavioral Health Emergency Care: Participants will be able to identify the critical gap between the rising number of behavioral health emergencies and the lack of adequate national, regional, or state-level responses in acute care delivery, treatment development, and care standards. This understanding will highlight the need for innovative local solutions.

Appreciate the Importance of Dual Perspectives in Care Delivery: Participants will take home concrete examples illustrating how a solid understanding of both patients' and healthcare workers' perspectives help provide effective and meaningful care. By recognizing patients' experiences, wishes, and goals, as well as the perceptions of healthcare workers, attendees will be better equipped to develop patient-centered, holistic, and therapeutic care strategies in emergency departments.

Implement Interdisciplinary Interventions in the ED: Participants will learn how to design and implement interdisciplinary ED-based interventions informed by patient and healthcare worker perspectives. Drawing from the research, clinical experience, and programmatic expertise presented, attendees will learn how to create supportive, healing environments for ED behavioral health patients, focusing on trauma-informed approaches to acute stabilization, treatment, and reassessment of both medical and psychiatric illnesses.