Emergency Psychiatric Intervention & Reducing ER Wait Times

Effective Psychiatric Treatment

Despite making up more than 12% of all emergency department visits, many behavioral health patients board in the emergency department, waiting for a bed that is difficult to find and likely unnecessary. These chaotic conditions raise the anxiety level for both patients and providers, degrading the care experience for all emergency department patients.

Emergency Psychiatric Intervention (EPI) is an approach and toolkit designed by Vituity physicians on the front lines of emergency medicine and acute psychiatry. EPI ensures that emergency departments are empowered to effectively evaluate and treat behavioral health patients from the moment they enter the emergency department.

If behavioral health emergencies could be handled as effectively as physical ones, it would dramatically change the quality of care and the economics of our emergency departments.

Scott Zeller, MD
Vice President of Acute Psychiatry, Vituity

How it Works

EPI creates core efficiencies to assess, evaluate, and treat behavioral health patients. The approach includes expertise and proven results in three areas:

Elimination of over-processing
Through the elimination of unnecessary roadblocks to expedite treatment, patients receive earlier assessments and differentiated care based on diagnosed need.

Risk stratification and split flow processing
EPI’s risk stratification tools allow clinicians to bypass unnecessary care steps (e.g., bloodwork) for low-risk patients. This improves time-to-discharge and frees up staff resources for moderate- and high-risk cases. 

Early and appropriate medication management
EPI’s medication protocols promote use of second-generation antipsychotics. These medications are less sedating than older antipsychotics and therefore don’t require extended emergency department stays. Clinicians also began offering medications earlier and in oral formulations, further reducing over-sedation and coercion.

To implement EPI, Vituity brings together clinical teams from multiple emergency departments in a collaborative learning program. Participants included medical, nursing, case management, and social work leaders from each participating emergency department. During a six-month program, the teams are provided comprehensive training on the treatment of behavioral health conditions, leadership coaching, introduction to EPI toolkits on de-escalation, risk stratification and medication protocols, as well as onsite visits from Vituity faculty.

Recognition for a proprietary care tool

In 2021, Vituity was recognized for the development of EPI by the American Foundation for Suicide Prevention (AFSP) and the American College of Emergency Physicians (ACEP).

Benefits: The EPI Advantage

For Patients

Faster time to provider and door to medication times, leading to less suffering

Decreased use of restraints

Stronger therapeutic alliance with physician, leading to use of less disorienting medications

For Clinicians and Staff

Increase in feelings of safety when caring for psychiatric patients

New confidence in ability to care for psychiatric patients

Rekindling the joy of practicing medicine

For Health Systems

Improved clinical quality and patient experience

Improved resource utilization and emergency department throughput, leading to measurable financial returns

Increased staff engagement and satisfaction

SPOTLIGHT TOPIC IN ACTION

EPI in Action: CommonSpirit Health

CommonSpirit Health implemented EPI in nine emergency departments via a six-month Collaborative. The program resulted in a number of improvements across the participating hospitals:

Door to medication times decreased from 158 to 44.5 minutes, and the percentage of patients receiving medications within an hour nearly doubled.
Use of first-generation antipsychotics decreased by 79% in favor of newer, less disorienting medications.
Length of stay for behavioral health patients dropped by 21 minutes during the intervention period while volumes for this population remained constant. Improvement continued over the next several months, eventually dropping by a total of 46 minutes.
Provider satisfaction. At the end of the collaborative, 34% of emergency department team members reported increased confidence in taking care of behavioral health patients and 82% reported a decrease in restraint use.

Partnering to improve patient lives

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