This book focuses on the operational and clinical strategies needed to improve care of Emergency Psychiatric patients. Boarding of psychiatric patients in ED’s is recognized as a national crisis. The American College of Emergency Physicians identified strategies to decrease boarding of psychiatric patients as one of their top strategic goals.
Currently, there are books on clinical care of psychiatric patients, but this is the first book that looks at both the clinical and operational aspects of caring for these patients in ED setting. This book discusses Lean methodology, the impact of long stay patients using queuing methodology, clinical guidelines and active treatment of psychiatric patients in the ED.
Table of Contents
Chapter 1: Introduction to Emergency Psychiatry
Chapter 2: Introduction to Lean Methodology
Chapter 3: Queuing Theory and the Impact of the Long Stay Patient
Chapter 4: Change Management and Cultural Barriers
Chapter 5: Metrics for Improvement
Chapter 6: Common Psychiatric Disorders in Emergency Department Settings
Chapter 7: Children and Adolescents with Psychiatric Emergencies
Chapter 8: Medical Problems Presenting as Psychiatric Complaints
Chapter 9: The Diagnosis and Management of Substance Use Disorders in Emergency Psychiatry
Chapter 10: Active Treatment Options used in Psychiatric Emergencies
Chapter 11: The Myths of Medical Clearance
Chapter 12: Treatment Teams and Operational Principles in the Emergency Department
Chapter 13: Emergency Psychiatry from an ED Physician Perspective
Chapter 14: Emergency Psychiatry from an ED Nurse Perspective
Chapter 15: Emergency Psychiatry from a Psychiatrist perspective
Chapter 16: Emergency Psychiatry from an ED Social Worker Perspective
Chapter 17: Emergency Treatment of Agitation in Delirious and Demented Patients
Chapter 18: Risk Assessment
Chapter 19: Discharge Planning
Chapter 20: Innovations in Treatment of Psychiatric Emergencies in a Hospital Setting
Chapter 21: Correctional Emergency Psychiatry
Chapter 22: Ethical Implications for the Psychiatrist in the ED
Yener Balan, MD, FAPA is a board certified psychiatrist and is currently the executive director of behavioral health for a major health care organization. He is a fellow of the American Psychiatric Association, has extensive years of experience working in high volume community emergency departments, is an expert on hospital operations, and has given lectures and workshops worldwide.
Yener was born and raised in New York City, and while he still misses the East Coast, has made a home for himself in Oakland, CA, where he lives with his wife and 5-year-old son.
Karen Murrell, MD, FACEP, MBA is board certified in emergency medicine and has her MBA with a focus on operations from the Physician Executive MBA program at the University of Tennessee. She is currently the physician lead for emergency medicine for a multihospital health care organization and is a fellow of the American College of Emergency Physicians. She is on faculty at the Institute for Healthcare Improvement and the Haslan School of Business at the University of Tennessee. Her expertise is in ED and hospital flow and Lean for healthcare. She has lectured extensively and published papers on these subjects.
Karen lives in Sacramento, CA, with her husband Richard, teenagers Jack, Maggie and Emily and their two dogs, Lucy and Larry.
Christopher Lentz, MS, LMFT is a licensed Marriage and Family Therapist practicing in the Northern California area. Christopher has 20 years of experience working in the mental health field working with a diverse range of patients, both in age and ethnicity. His experiences range from direct patient assessments and counseling in an outpatient setting, to administrative leadership in an emergency department setting. Christopher has also served as a direct care mental health clinician for a publicly funded inpatient psychiatric facility, providing psychiatric assessment, diagnoses and case management services for the facility. Christopher has acted as a front line emergency department mental health clinician for many years, providing psychiatric assessment, diagnoses, treatment plan recommendations and discharge plan recommendations to emergency department care teams. He has also served as an administrator for the psychiatric consultation services of one of the busiest emergency departments in Northern California, helping to transform and drive the level of psychiatric patient care to new heights.
Christopher currently acts in a consultative role for a major healthcare organization. He resides in Northern California with his wife and two children.
"All clinicians in Emergency Departments espouse to provide care for the whole person, yet those individuals with psychiatric and mental health conditions in EDs all too often find timely and competent care woefully lacking.
Similar to the recent trends of integrating mental health services into primary care, this book provides expertise and practical guidance for ED physicians and nurses to increase competencies for diagnosing and treating common mental health conditions.
This innovative model of care in EDs proactively and reliably addresses the majority of patients’ psychiatric and mental health needs, and reserves psychiatric consultation services and transfers to psychiatric treatment facilities for those patients who cannot be adequately treated by ED clinicians."
Patricia Rutherford, RN, MS
Institute for Healthcare Improvement (IHI)
"The authors not only have a deep understanding of emergency psychiatry but also of operational improvement. The mix makes this book a needed reference for anyone focused on a patient centered approach for this vulnerable population."
Kevin Nolan, Statistician, Improvement Advisor, and Senior Fellow
Institute for Healthcare Improvement (IHI)
"The authors have organized and written a timely and necessary book on the care of the acute psychiatric patient in the Emergency Department.
Over 2 million people a year seek care for behavioral health care problems in hospital EDs at a cost of over $4 billion.
Behavioral health patients seeking care in the emergency department have the same hopes, needs, and fears as the rest of the patients who present to our EDs for evaluation and treatment.
The ED is often an intense and stressful work environment where staff must perform rapid assessments and make swift treatment decisions.
ED staff and team members, dedicated, focused, and highly trained, too often feel overwhelmed, burdened and at times even threatened by the need to provide care for behavioral health patients.
There is a great deal of variation in ED expertise, training and resource allocation for emergency mental health problems, which can lead to sub-optimal care and negative patient and staff experiences.
The management of acute behavioral emergencies and crisis intervention are simply and clearly described in this book. The tactics, tools and techniques outlined here can elevate our approach to emergency department psychiatry and allow our emergency medicine colleagues to rise above our current challenges and frustrations.
Balan et al. apply approaches, lessons and insights from both evidence - based medicine and Lean service operations to behavioral health patients, defining best practices and demonstrating the benefits and positive impact on patient care, flow and safety.
Big Book of Emergency Department Psychiatry is a practical playbook for the challenges at hand. The authors explain simply and clearly how to get it done."
Kirk Jensen, MD, MBA, FACEP
Chief Innovation Officer, EmCare, Inc.
Chief Medical Officer, BestPractices, Inc.
Studer Faculty Member and National Speaker
Institute for Healthcare Improvement (IHI) Faculty Member
"The management of psychiatric patients seeking care in the emergency department is one of the most complex and important issues in modern emergency medicine. The patients are frequently disenfranchised and do not receive high quality or timely medical care. As a result, these patients impose a tremendous impact on ED resources and flow.
This book provides comprehensive insights into psychiatric care in the ED and operational improvement using Lean Healthcare concepts. It will help you and your leadership team create a patient-centric culture where a community of scientists continuously improve value for psychiatric patients, hospital and society."
Jody Crane, MD, MBA
Principal, X32 Healthcare
Author of "The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the "No Wait" Department"
"Innovative, informative and inspiring book, with captivating stories that display the ins and outs of psychiatric emergency services. A must read, especially the chapters on correctional emergency psychiatry and the concept of Lean in healthcare."
Mardoche Sidor, MD
Assistant Professor of Psychiatry, Columbia University
The Center for Alternative Sentencing and Employment Services (CASES)
"Big Book of Emergency Department Psychiatry is big as it should be; it is the most comprehensive text on emergency psychiatry in print. Not only does it guide one to the diagnosis and management of emergency room patients but it also addresses operational issues in various settings. The emergency room is a team effort and Big Book of Emergency Department Psychiatry includes the perspectives of its members: psychiatrist, nurse, social worker and non-psychiatric emergency doctor.
Make room for it on your bookshelf."
David W Preven, MD
Department of Psychiatry and Human Behavior
Albert Einstein College of Medicine
"Complete, accurate and especially timely. A must read for any emergency department leader engaged in improving care for this vulnerable population."
Seth Thomas, MD, FACEP
Director of Quality & Performance
"Big Book of Emergency Department Psychiatry is empathically written and valuable to anyone that has ever experienced or cared for someone dealing with a psychiatric emergency. It has a dose of rigor, evidence and science and it conveys the personal experience of some of our peers and it keeps you wanting to read more. It is a tremendous compendium of the state of knowledge of the specialty and art of emergency psychiatry.
Very soon, this book will become the must-read for this specialty for trainees and experienced mental health professionals alike.
I congratulate the authors on an excellent, disciplined, rigorous work that retains the human perspective while educating the reader."
Carlos Rueda MD, MBA
Chairman, Department of Psychiatry
St. Joseph’s Healthcare System
Trinitas Regional Medical Center