Case Studies

Memorial Hermann Health System - Psych Response Team

Houston, TX

Houston is struggling with a mental health crisis. With a shortage of psychiatric facilities and a lack of financial resources, insured and uninsured patients are left seeking services from emergency department (ED) physicians and nurses untrained in psychiatry. They face problems that are pressing and real, yet typically wait while ED personnel attend to others with more pressing physical needs. Within the Memorial Hermann Health System, an innovative mental health program strives to address the community need.

Memorial Hermann envisioned an innovative solution for this community crisis, and in 2000 the Psych Response Team, made up of Master’s-level licensed clinicians, was born. The Team works 24/7 across the system and provides mental health expertise to all acute care campuses, delivering services to EDs and inpatient units. The Team responds to behavioral health patient needs, ranging from depression, psychosis, or chemical dependency. The clinician will evaluate, stabilize, arrange all aspects of acute psychiatric transfers, both voluntary and involuntary, and develop aftercare plans for outpatient discharges so that patients can follow up to maintain treatment compliance.

The Team refers to 200+ mental health community treatment providers within Harris, Fort Bend, and Montgomery Counties. This large referral network enables the program to leverage the mental health community’s resourced patients (65 percent) to obtain care for the community’s non-resource patients (35 percent). No longer is one ED/nurse/physician competing with all local EDs for limited psychiatric resources. The Psych Response Team manages all psychiatric outbound traffic for the Memorial Hermann Health System with an enterprise-wide view of real-time psychiatric needs for the organization. This coordinated approach engages psychiatric providers to collaborate with and accept Psych Response Team patients because this program has a proven 17-year record of doing the right thing at the right time for each patient. Psych Response Leadership meets monthly and includes both private and public psychiatric hospitals to ensure coordinated operations are working well, and issues and problems are addressed quickly and efficiently.

The Team was developed with the mission of freeing up EDs, working collaboratively with the behavioral health community to increase access to care, and leveraging resourced volumes against non-resource volumes to provide placement for all patients in need. In 2005, the program integrated telemedicine technology into the service delivery model. Communicating with patients and ED staff via technology and video cameras based at the Team’s main office has driven response time to the most remote EDs.

The Psych Response Team has reduced ED average length of stay for psychiatric patients needing an inpatient psychiatric bed. In 2000, the average length of stay for this patient population was 72 hours. Currently, the length of stay for this patient population is 5.5 hours. Shortening the wait time has released costly ED beds as well as reduced the need for sitters for the most acute psychiatric patients. The efficiencies are dramatic. Each dollar spent on the Psych Response Team results in medical inpatient bed savings.

Emergent psych patient volumes have increased approximately five percent per year since FY2007. Since 2000, approximately 73,000 patients have been screened by the Psych Response Team and close to 63,000 patients moved out of the system and into the most appropriate behavioral health settings. The Team has not encountered one sentinel event due to care delivery. This successful track record points to solid psychiatric expertise at the bedside as well as comprehensive protocols for care delivery.

Lessons Learned
Individuals with chronic mental health conditions struggle with non-compliance in prescribed health maintenance activities, such as medication management, follow-up, and Medicaid enrollment activities. It is also very challenging to recruit competent behavioral health staff to provide 24/7 services. To address these challenges, Memorial Hermann is engaging in an aggressive recruitment campaign and will deliver services in a manner that places the patient at the center of care decisions, shown to improve the behavior of non-compliant patients.

Future Goals
The Psych Response Team also benefits from adjunct services such as Case Management and Mental Health Crisis Clinic services for its patients. A current goal is to provide a 24/7 liaison to act as an adjunct to the Psych Response Team to provide more intensive case management of “post-discharge” behavioral health patients to reduce recidivism and increase compliance with follow-up.

Elizabeth LoCaste
Manager, Community Benefit Programs
Telephone: 713-338-4446

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