The Daily Item, Sunbury, PA


January 23, 2013

Psychiatric patients wait in ERs as inpatient beds are scaled back


Meanwhile, more and more people are turning to emergency rooms for health care nationwide. ER visits increased by 32 percent from 1999 to 2009, and overall ER wait times for all sorts of ailments have also gone up, according to a Centers for Disease Control and Prevention report. Psychiatric patients make up 7 to 10 percent of emergency room visits, said a 2012 study in the Emergency Medicine International journal.

For many patients suffering from psychiatric crises, this translates to longer waits in emergency departments, where they receive no treatment for days — and sometimes weeks — while social workers try to chase down open spots in psychiatric wards, doctors said.

Jeff Sternlicht, chairman of emergency medicine at Greater Baltimore Medical Center, said that years ago patients stayed in emergency rooms only a few hours but that now the average time for a transfer is 15 hours — and some stay as long as three days.

Almost every day, patients who are suffering from hallucinations or who have attempted suicide flood Sternlicht’s emergency department. One patient had to be physically restrained because he kicked and punched emergency room nurses during a psychotic episode, Sternlicht said.

“The ER department is designed for acute care,” Sternlicht said. “It’s far from the ideal place to be if you’re a psychiatric patient.”

Patients who have disabilities or special needs, conditions that frequently occur with mental illness, are especially hard to place. Joel Klein, vice chairman of the emergency department at Baltimore Washington Medical Center in Glen Burnie, Md., said that anecdotally, the incidence of boarding has risen at his hospital in recent years, particularly for patients who require an inpatient room with grab bars, specially trained staff or other accommodations.

“Those patients often stay for multiple days waiting for a bed,” he said.

Insurance coverage, which sometimes pays for inpatient treatment at only certain hospitals, further complicates matters. Heather Carpenter of Baltimore rushed her 15-year-old son to Medstar Franklin Square Medical Center in that city when he attempted suicide in May. But even though Franklin Square had beds available, he was boarded overnight because her insurance network included only hospitals with unavailable beds.

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