Washington's Emergency Physicians Applaud Stay for Psychiatric Boarding Ruling
Emergency physicians in Washington State applaud the Supreme Court's decision today to grant a 120-day stay to its recent ruling that ends the practice of psychiatric boarding in the Emergency Department.
"We are grateful that the Supreme Court gave us the time to implement an emergency action plan to care for these vulnerable patients," said Nathan Schlicher, MD, JD, secretary/treasurer of the Washington Chapter of the American College of Emergency Physicians (WA-ACEP), which represents more than 700 emergency physicians in the state. "We look forward to working with the state and legislature to ensure that patients enduring a mental health crisis can get the care they need."
The Washington State Supreme Court determined Aug. 6 that psychiatric boarding was unconstitutional and violated the state's Involuntary Treatment Act. WA-ACEP joined other healthcare groups Aug. 22 in support of a motion by the Department of Social and Health Services asking the court to grant a temporary 120-day stay of the decision after a plan to open 145 beds was developed in concert with the Governor's Office. The motion stated that if the decision took effect as planned, it could pose a serious public-safety risk as hospitals and provider groups consider the possibility of having to release patients with severe mental health issues that met the need for detention and treatment, but were turned away due to a lack of an available bed.
The court's decision today means that the process used for Single Bed Certifications will remain in effect until Dec. 26. Between now and Dec. 26, the state will be bringing online and providing ongoing payment for 145 new treatment beds for involuntarily detained patients. Many of these beds are located at freestanding psychiatric hospitals.
"Washington's emergency department physicians will continue to take an active leadership role in finding a comprehensive plan that protects patients and communities," said Schlicher.
WA-ACEP reminds all of its practitioners to keep our EMTALA mandate of providing basic screening and stabilization to all presenting ED patients as we continue to work with our community partners in finding the right solution to this issue.
(September 5, 2014)
Washington's Emergency Physicians Urge Stay of Boarding Decision
SEATTLE— The Washington Chapter of the American College of Emergency Physicians (WA-ACEP) is adding its voice to a call from throughout the state's medical community; urging the Washington State Supreme Court to grant a 120-day stay to its recent decision ending the practice of psychiatric boarding.
WA-ACEP has joined a wide variety of organizations supporting a petition from the Washington State Department of Health and Social Services to the Supreme Court requesting the stay.
"Although we strongly support ending the practice of psychiatric boarding, Washington's emergency department physicians also support doing so in a thoughtful, well-planned manner," said Nathan Schlicher, MD, JD, secretary/treasurer of WA-ACEP. "A 120-day stay will keep Washington state government and medical providers focused on putting needed services in place quickly, while still ensuring that patients, their families and their communities can be safe while capacity is increased."
In supporting the stay, the emergency physicians join a diverse group from across the state's health-care community, including the Washington State Hospital Association, Washington State Medical Association, Washington Organization of Nurse Executives, Washington State Nurses Association, SEIU Healthcare 1199NW, and the Washington Council of Emergency Nurse Association, Franciscan Health System and the MultiCare Health System.
Emergency physicians are pleased to see the state and providers working hard to find alternatives to the practice of boarding patients in psychiatric crisis in emergency rooms, Schlicher said. "But there is no instant solution to meeting the needs of the entire state.
"We look forward to continuing to work together to find solutions that will ensure that patients enduring a mental health crisis can get the care they need."(August 25, 2014)
WA-ACEP Board Member Darin Neven, MD, co-authors Important Care Coordination Article
Cost Effective: Emergency Department Care Coordination with a Regional Hospital Information System
Sean M. Murphy, PHD and Darin Neven, MS, MD
Update: Gov. Jay Inslee's office put out word Aug. 8 to health officials that they have until Aug. 27 to comply with the state Supreme Court decision to outlaw the warehousing of psychiatric patients in emergency departments. Inslee's message comes as mental-health professionals scrambled to find immediate treatment alternatives for patients instead of just turning them away. After the court's decision, officials believed they had to act immediately.
The Washington State Supreme Court ruled Aug. 7 that boarding psychiatric patients temporarily in hospital emergency departments and acute care centers because there isn’t space at certified psychiatric treatment facilities is unlawful. See the Supreme Court’s opinion.
As of 2:30pm today, the understanding from the Attorney General's Office is that effective Aug. 8 they will not be detaining patients to single bed certifications in many communities. We are actively working to a solution on this and hope that it will find a resolution, but you should know that there is a possibility you will be told that a patient must be released as no bed is available.
If this happens, the recommendation from Washington State Hospital Association (as sent out to their members this morning) is that each hospital has its own plan of action in how to deal with this. I wanted to let you all know so that if you have not heard from your administration that you consider reaching out proactively to folks to start making plans on how you will handle this situation, especially over the weekend.
We still are hopeful that there will be a resolution, but at this time I am not certain that will be the case by any means. While this is not the ideal solution we sought, the movement forward on stopping the practice of psychiatric boarding is encouraging. Now we just need to get to the hard work of solving the problem.
Nathan Schlicher, MD, JD
WA-ACEP Secretary-Treasurer and Legislative Chair
WA-ACEP Joins Amicus Brief to Address Boarding of Psychiatric Patients in EDs
Washington ACEP joined the Washington State Medical Association, Washington State Hospital Association and Washington Emergency Nurses Association in an amicus curiae brief in a case related to boarding psychiatric patients. The case was recently accepted for review by the Washington State Supreme Court.
The question before the Court is whether patients in need of mental health treatment can be detained against their will while they are not receiving meaningful mental health treatment. The plaintiffs are challenging the commitment process whereby patients are declared in need of involuntary inpatient psychiatric treatment, but because no psychiatric beds are available, the patients are housed in emergency departments or other locations where no such treatment is available. The State's position has been that some "treatment" in emergency departments is better than the patients staying on the streets as a danger to self or others.
The underlying problem is that the state budget for mental health treatment has been cut deeply over many years. Hospitals board the patients because there is nowhere else for them to go; beds are not available at evaluation and treatment centers or at the two state psychiatric hospitals. As a result, emergency physicians and staff are forced to grapple with the complex psychiatric needs of patients.
The case could significantly impact the way Washington state funds treatment of involuntarily committed patients with psychiatric conditions. The case is on an expedited schedule; the Court will hear oral arguments June 26.
WASHINGTON'S LACK OF SUPPORT FOR EMERGENCY PATIENTS RECEIVES A NEAR-FAILING D+
Washington dropped to 35th place in the nation with a D+ in the American College of Emergency Physicians (ACEP) America's Emergency Care Environment: A State-by-State Report Card released January 16. In 2009, the state ranked 19th in the nation with a C. While our State ranks in the top 10 in the categories of Public Health and Injury Prevention, and Quality and Patient Safety, Washington received failing grades in three out of five categories.
• Access to Emergency Care - F
• Quality & Patient Safety Environment - B
• Medical Liability Environment - F
• Public Health and Injury Prevention - A
• Disaster Preparedness – F
Since 2009, our State did improve its overall ranking in the category of Access to Emergency Care. Washington still received a failing grade in this category, in part because of a severe lack of resources and inpatient capacity for mental health patients. The state also has some of the lowest levels in the nation of staffed inpatient and intensive care unit beds. To improve our grade, Washington must make greater investments in hospital infrastructure and mental health care, according to the Report Card. Read more.
The Report Card evaluates conditions under which emergency care is being delivered. The Report Card does not measure the quality of care provided by hospitals and emergency providers. For more information, please visit the links below:
What you can do to help Emergency Medicine in Washington State:
• Send the WA-ACEP Press Release to your local media outlets. Please contact the WA-ACEP office if you need media information.
• Use the talking points to draft a Letter to the Editor for your local newspaper. Please coordinate this effort with the WA-ACEP office.
• Contact your State House and Senate Members. Reference the talking points "Solutions" in your message.
ACEP JOINS CHOOSE WISELY
The College announced at the annual meeting that it has joined the Choosing Wisely campaign. ACEP released its list of five tests and procedures that may not be cost effective in some situations and should prompt discussion with patients in order to both educate them and gain their agreement regarding avoidance of such tests and procedures, when appropriate. Learn more. View the WA-ACEP Choosing Wisely Powerpoint Presentation for more information.
ACEP13 in Seattle: Largest Attendance in the Meeting's History
Although ACEP13 has ended and the more than 7000 attendees have departed Seattle, the buzz from the meeting will linger and remain palpable over the coming year. Because of your support, attendance, and leadership, ACEP13 is now THE most successful ACEP conference ever! Thank you! Attendance at the kickoff party and our own Space Needle reception marked record-setting numbers as well.
The visibility, credibility, and respect garnered will serve this chapter well for many years. Thank you for your continued support of the Chapter, College and Emergency Medicine!
Mrs. Wilkerson, ACEP Executive Director Dean Wilkerson, Washington Lt. Gov Brad Owen and WA-ACEP Past President Steve Marshall at the WA-ACEP Space Needle Reception during ACEP13.
ACEP13 Sets Records!
ACEP13 held in Seattle during October set four-day attendance records that exceeded 7000 members! In fact, ACEP13's Opening Party at Seattle Center and Closing Reception at the Museum of Flight had the highest attendance of any similar type events in the meeting's history.
The WA delegation poses with ACEP Staff, Dean Wilkerson, Sonja Montgomery and Craig Price.
Other highlights of the meeting:
• Three Resolutions were approved by the national Council
• WA ACEP members served on a national Pre-Conference Workshop and 10 national Committees
• WA ACEP Journal Club went national as Drs. Enrique Enguidanos and Stephan Anderson presented a medical marijuana session
• Members of the WA ACEP Board of Directors were able to talk in person with national ACEP staff on the Fair Billing Issue, Regionalization of Care, research on the impact of the legalization of marijuana on emergency departments, nationalization of an Opioid Prescription Monitoring System, and upcoming release of the National Report Card on the State of Emergency Medicine.
Because of your support and attendance, ACEP13 is now THE most successful ACEP conference ever!
RAND: ER Docs are Key to Reducing Health Care Costs
Emergency physicians are key decision makers for nearly half of all hospital admissions, highlighting a critical role they can play in reducing health care costs, according to a new report from the RAND Corporation. Download a free copy of the RAND report.
Hospital admissions from the ER increased by 17 percent over seven years, accounting for nearly all the growth in hospital admissions between 2003 and 2009. Hospital inpatient care is a key driver of health care costs, accounting for 31 percent of the nation's health care expenses.
"This report tells policymakers and hospital administrators that they should pay closer attention to the role that emergency physicians play in evaluating, managing and preventing hospital admissions," said Dr. Andy Sama, president of the American College of Emergency Physicians. "Clearly, emergency departments must be fully integrated in health care delivery systems for both inpatient and outpatient care."
Hospital admissions grew from 34.7 million to 36.1 million, offset by a 10 percent decline in admissions from primary care physicians and clinical referrals. Nearly all of the increase was from "non-elective" admissions from the emergency department — a rate 3.8 times the rate of population growth.
Increased admissions were highest among people ages 65 and older. Self-pay patients were less likely to be admitted to the hospital than patients with health insurance. The role ERs and emergency physicians play in deciding who to admit to the hospital is critical to hospital cost savings, since the average cost of an inpatient stay ($9,200) is roughly 10 times the average cost of a comprehensive emergency visit ($922).