PERSPECTIVE

EmPATH Units: Better Care for Patients in Psychiatric Emergencies

Now, more than ever, patients are seeking emergency care for suicidal ideation, adding immense strain to an already overburdened healthcare system.

Fortunately, an alternative care model called EmPATH (Emergency Psychiatric Assessment, Treatment, and Healing) transforms how hospitals treat patients in a behavioral health emergency, offering a more effective and compassionate approach.

Scott Zeller , MD

Vice President of Operations, Acute Psychiatry

Published September 26, 2024

The Escalating Mental Health Emergency

In recognition of Suicide Prevention Month, it’s imperative to spotlight the urgent need for innovative care solutions. Behavioral emergencies have surged to represent one in every seven patients in emergency rooms across the nation, with 12% to 15% of all emergency department visits linked to mental health concerns. Alarmingly, the pandemic has exacerbated this crisis, with emergency visits for suspected suicide attempts among adolescents aged 12-17 increasing by 31%. These statistics underscore the critical role of reimagining how we approach mental health care in emergency settings.

Unfortunately, most of these patients endure long wait times while little is done to alleviate their acute distress. They often face extended boarding in chaotic environments ill-suited for managing psychiatric crises. Additionally, they’re at increased risk for unnecessary psychiatric admissions.

Emergency Departments Are Not Equipped to Treat Suicidal Patients

When a person experiences suicidal ideation, the standard protocol for clinics, schools, and law enforcement is to send them to the emergency department; However, most emergency departments are ill-prepared to care for these vulnerable individuals.

Busy, noisy environments exacerbate anxiety and distress. Agitated patients are often left isolated and waiting for hours — or even days — for evaluation, treatment, and disposition. Many wait in rooms or hallways under the supervision of sitters, which is costly and reduces overall emergency department productivity. Psychiatric boarding also lowers bed turnover rates, affecting the care of other patients.

Many emergency physicians don’t feel adequately trained or confident in assessing and managing suicidal ideation. As a result, a large majority of these patients are admitted to inpatient psychiatric units, whether or not hospitalization is the most appropriate course of action. If we admitted chest pain patients at the same rate (rather than the typical 10–20%), they would likewise overwhelm the system.

This inequity highlights the need for a more tailored and effective approach to psychiatric crises — one that EmPATH units aim to provide.

Open an EmPATH Unit in your Hospital

Want to learn more about how EmPATH can help you meet the growing demand for acute behavioral healthcare?

More Compassionate Approach

As Chief of Psychiatric Emergency Services at Alameda Health System for nearly thirty years, I saw firsthand the suffering psychiatric patients endured in emergency rooms. This inspired me to develop what would become EmPATH, a new care model that provides expert behavioral health treatment in a supportive, therapeutic setting. At Vituity, we continue to refine and research the EmPATH model and have helped over 60 health systems implement it.

Unlike the traditional emergency department environment, EmPATH units provide a space designed specifically for patients in emotional and psychological distress. For medically cleared patients in crisis, the EmPATH unit is not just an alternative to inpatient psychiatric care but the primary destination for initial evaluation and treatment.

What sets EmPATH units apart is their inclusive, "no exclusion" philosophy. All behavioral health patients — regardless of the severity of their condition — receive immediate evaluation and treatment from a psychiatrist. Patients are constantly observed, and their care is frequently re-evaluated to ensure progress. The environment is calming and distinctly different from the chaotic medical ED, helping foster a sense of healing and recovery.

EmPATH units also emphasize a wellness and recovery-oriented approach. The goal is to minimize anxiety and frustration while providing timely care that prevents unnecessary inpatient admissions. This approach benefits both the patient (by addressing their needs sooner) and the hospital (by allowing for more efficient use of resources).

EmPATH Improves Patient Care and Hospital Efficiency

A 2022 study conducted at an academic medical center in Iowa underscores the profound impact EmPATH units can have on both patient care and hospital efficiency. Published in the Journal of Academic Emergency Medicine, the study analyzed outcomes for 952 patients presenting with suicidal ideation or suicide attempts, comparing patient data before and after the introduction of an EmPATH unit.

The results were compelling:

Reduced length of stay: The average length of stay for psychiatric patients in the emergency department decreased from 16.2 hours to just 4.9 hours — a 70% reduction. This drastic improvement allowed patients to receive timely psychiatric care without long, stressful waits in the ED.
Lowered recidivism: The 30-day return rate of psychiatric patients to the emergency department dropped by 25%. This indicates that patients received more effective care during their initial visit and didn't need to return for further treatment.
Fewer inpatient admissions: Inpatient psychiatric admissions dropped by 53%, decreasing from 57% of patients to just 27%. This shift reflects a more thoughtful approach to care that prevents unnecessary hospitalization.
Improved outpatient follow-up: After the introduction of the EmPATH unit, outpatient follow-up rates increased from 39.4% to 63.2%, a 60% improvement. Ensuring that patients remain engaged in their treatment after discharge is crucial for long-term recovery.
Positive financial impact: In the first year alone, the EmPATH unit contributed $861,000 to the emergency department’s bottom line by moving behavioral health patients out of the general emergency department and into more appropriate, specialized care.
Shorter inpatient stays: For those patients who required inpatient admission after EmPATH, the length of stay was reduced, leading to better resource management and quicker patient recovery.

We Need More EmPATH Units

The evidence is clear: EmPATH units provide superior care for patients in psychiatric emergencies. The Iowa study is just one example of the positive impact EmPATH can have on patient care and hospital efficiency. Other studies have shown similar results, reinforcing the need for more EmPATH units nationwide.

As the number of patients experiencing psychiatric emergencies continues to rise, the need for more EmPATH units becomes increasingly urgent. These units offer the best chance for patients to receive prompt, compassionate care and to begin their healing process in the right setting.

Expanding the availability of EmPATH units nationwide will benefit patients and create a more efficient, cost-effective healthcare system that meets the growing demand for mental health services.

To learn more about EmPATH and how it can help your facility meet the growing demand for acute behavioral healthcare, contact empath@vituity.com.

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