Can Howard County Hospital reduce emergency room wait times with a new behavioral health unit?

At any given time, the emergency room at Johns Hopkins Howard County Medical Center treats an average of 11 patients with mental health or substance abuse crises on a single unit. Equipped for only six of them. Dr. Shafeeq Ahmed, hospital director, said behavioral health patients in the emergency room often have to wait 24 hours to be transferred to a facility with open beds.

But next fall, Howard County Hospital will quadruple the number of behavioral health beds. Construction is about to begin on a more modern, more therapeutic, 7,000-square-foot transitional space that will house 24 patients while they await admission to an inpatient facility or are stable enough to be safely discharged.

It may also shorten emergency room wait times for others.

This is really a great initiative for the behavioral health population that comes to the emergency room, Ahmed said. But it also does help if you use the emergency room in general because it opens up space for people who don’t have mental issues.

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Patients who require hospitalization to recover from a mental health crisis are often unsafe because they are suicidal, homicidal, or experiencing symptoms of severe mental illness and must be admitted to the emergency room until an inpatient bed can be found.

Delayed discharges of behavioral health patients contribute to one of the longest emergency room wait times in the nation in Maryland. A 2019 study by the Maryland Hospital Association found that 42% of behavioral health patients experienced discharge or transfer delays, and these wait times accounted for nearly half of the time they spent in the emergency room, totaling an average of 20 per patient. Hour.

The same study found that children and teenagers had twice the latency as adults.

According to the hospital association, emergency room visits for behavioral health increased by 12% between 2016 and 2020, while visits for all other reasons decreased by 11% during the same period.

Spending long periods of time in an already crowded emergency room, an area unsuited for specialized psychiatric care, can also lead to worsening of mental health symptoms.

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Howard County Medical Center has 20 inpatient psychiatric beds for adults and Sheppard Pratt, A psychiatric hospital in Elkridge provides an additional 85 beds for adults and adolescents. Otherwise, patients who go to the emergency room and need more intensive care will be transferred to other psychiatric facilities across the state, depending on available space and their individual needs, Ahmed said.

Howard County Medical Center’s pediatric emergency room has a behavioral health unit that can accommodate four children, but the hospital does not have an inpatient psychiatric unit for children, and Howard County does not have other units, Ahmed said.

Emergency departments bear a disproportionate burden of behavioral health care because patients are easily exposed to them. Most outpatient psychiatrists or psychotherapists do not accept public insurance, and many only accept cash.

Psychiatrists are by far the least likely of all internal medicine specialists to accept any type of insurance, but the high demand for mental health care means they can practice a busy schedule without insurance.

Ahmed said when patients with mental health issues don’t have access to outpatient care, their conditions worsen and they really need urgent mental health help. The emergency room is often their only option.

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Then, once patients are discharged, whether from the emergency room or inpatient care, connecting them to consistent outpatient care can help prevent mental health crises and repeat trips to the emergency room is one of the challenges we continue to face; not just for this hospital but for all hospitals, Ahmed said.

Sarah True is a public health reporter for The Baltimore Standard. She previously worked as a freelance journalist covering health care and health policy and as a medical social worker and health policy analyst. She holds dual master’s degrees in public health and social work.

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