Detection, Treatment and Follow-up of Unrecognized Behavioral Health Problems in the Emergency Department

Behavioral health (BH) problems frequently exacerbate medical conditions of emergency department (ED) patients and contribute to ongoing suboptimal healthcare utilization. Because non-crisis BH problems are often undetected in the ED, we evaluate an innovative model of care that incorporates a BH resource person in the ED to address the BH concerns of non-critical ED patients. This evaluation study examines the feasibility and impact of this model of care on patients’ service utilization patterns in a before/after interventional study design. We characterize the types and scope of BH problems among all adult (18+ years old) patients with non-critical medical conditions presenting for care in the San Leandro Medical Center ED during a 16-month period (8 months pre-implementation of the BH resource person and 8 months post). Our research questions are: (1) To what extent does this model of care improve the detection, brief treatment, and follow-up of ED patients with non-crisis BH conditions? (2) What is its impact on ED patient flow as well as care team attitudes toward behavioral problems? We will use the electronic health record to characterize BH diagnoses and symptomatology among the non-critical ED population as well as to measure rates of specialty BH treatment (Psychiatry and Chemical Dependency) referral, initiation and engagement, ED and primary care utilization, and use of KPNC electronic resources, such as the patient portal. We also examine the feasibility of embedding a BH resource person in the ED.

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