Banner Behavioral Health Hospital – Emergency Department Telepsych Triage

Overview

Banner Health recently launched a telemedicine program in which master’s-level therapists, counselors, and other trained clinicians, backed up by physicians and nurse practitioners, triage behavioral health patients who arrive in the emergency department (ED). Banner already had a team of clinicians responding in person to their EDs, but more support was needed. This effort is part of a larger, ongoing initiative to better serve patients who require behavioral health services.

“We have 19 emergency departments in the Phoenix metro area that consistently see behavioral health patients, and we were seeing that number increase each year,” says Brian Beutin, CEO of Banner Behavioral Health. “So about seven years ago, we opened an urgent care site, the Banner Psychiatric Center, so that those patients could be transferred to that facility from the emergency departments.”

Initially, the center was successful in moving behavioral health patients from the EDs and decreasing ED wait times. Patients received evaluation, observation, and 23-hour service at the center. But as patient volume continued to rise and the community learned how it worked, patients started going straight to that campus on their own. Eventually, nearly half of Banner Behavioral Health Hospital (BBHH) patients were walk-ins, and the numbers of behavioral health patients arriving at the EDs began increasing again.

“That’s why we began this latest program, to help triage these patients and get them the care they need quickly,” Beutin says.

Additionally, the system is working with payers and the local Medicaid managed care organization to facilitate collaboration with community organizations so that they might come to BBHH and pick up patients who need services but not inpatient treatment. BBHH also recently hired a full-time psychiatric provider in their outpatient clinic to oversee medication management.

Impact

“Overall, we have about 50,000 patients a year who receive behavioral health consultation at Banner facilities,” Beutin says.

To ensure that those patients get treated in a timely manner, the organization kicked off a process improvement effort last year. Through that initiative as well as the new behavioral health programs, they were able to reduce the average adult throughput time for behavioral health from 24 hours to 15 hours. Additionally, ED wait times are again decreasing.

Lessons Learned

“The main lesson we learned is that we can’t implement a program and decide that it’s going to work as is for the long term,” Beutin says. “A program may work well at first, but community needs change, so programs need to change with them. We need a multi-faceted approach.”

He adds that the organization has learned that they can’t be “all things to all people,” which is why the relationships with community organizations are so important.

Future Goals

BBHH is in the process of opening a new, 96-bed patient tower at its freestanding hospital. The phased launch began in April 2017. As more units continue to open, the organization anticipates being able to move behavioral health patients more quickly from the EDs.

Meanwhile, they also are looking to expand behavioral health services, making more crisis therapists and psychiatrists available to provide services in observation units and conduct floor consultations.

“We’re also working with attendings in the EDs to see how they can be more prepared,” Beutin says, “and learn what tools we can give them to work with behavioral health patients. We’re looking at this type of care from a team standpoint.”

Contact: Brian Beutin
Chief Executive Officer
Telephone: 480-941-7500
Email: brian.beutin@bannerhealth.com