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Ohio ACEP Fast Fax Program Targets Challenge of Psych Holds in the ED

On July 26, 2010, the Ohio Hospital Association (OHA), the Ohio Chapter, American College of Emergency Physicians (Ohio ACEP) and the Ohio Psychiatric Physicians Association (OPPA) kicked off a Fast Fax data collection project with hospital emergency departments with hopes of gaining quantifiable data to demonstrate the extent of the problem of psychiatric holds in Ohio’s emergency departments. Hospital emergency departments continue to face a critical breaking point, holding patients in need of behavioral health services for hours and often days at a time. Psychiatric Holds in Emergency Departments Letter

To demonstrate to state officials the dire situation facing our emergency departments today, the OHA and Ohio ACEP have asked emergency department physician directors, ED nurse managers, and behavioral health administrators to work with emergency department staff to participate in a reporting study, focusing on patients waiting in excess of 12 hours.

The FastFax ~ 12-Hour Wait Reporting for Psychiatric Patients will help us gather information over a distinct period of time.  For each 12-hour interval that a patient is held in your emergency department, the Fast Fax should be completed and faxed back to OHA at (614) 358-2703.  The FastFax should be returned in real time – anytime, 24/7. FastFax ED Reporting Form

The aggregate data collected from the survey will be shared with officials in the Ohio Department of Mental Health, the Ohio Department of Insurance, members of the Coalition for Healthy Communities (32 statewide organizations working together to address issues related to behavioral health, including appropriate funding, insurance coverage/denials, etc.) and Ohio legislators so that we can address the ongoing crisis of delays for placement of patients seeking behavioral health services. The data will also assist the Ohio Chapter ACEP in making priority legislative goals.

Four years ago, the New Jersey Hospital Association (NJHA) and NJ-ACEP targeted psychiatric holds in the ED as a priority issue. 

Several NJHA surveys tracked the extent of this problem in the state’s emergency rooms. Key demographic information was gathered for psychiatric patients who remained in the emergency department at 12-hour intervals. In a New Jersey example, in one three-week period, participating hospitals reported more than 1,300 episodes where a patient waited more than 12 hours for placement in an appropriate service. Of those episodes, roughly 90 percent were waits of approximately 48 hours after medical clearance, while others waited for placement anywhere from 60 to 156 hours. Approximately 70 percent of the cases were patients awaiting placement in a short term care facility bed or county or state psychiatric facility, while just over 8 percent were awaiting placement in a community-based program.

New Jersey used the Fast Fax data to successfully secure legislation that addressed the issue of behavioral health patients languishing in hospital emergency rooms waiting for placement in a mental health service. State Efforts to Address Psych Hold Issues  

Please encourage the personnel in your emergency department to participate in this Fast Fax 12 hour wait survey so that we can collect solid data on the issue of patients waiting in the emergency department for psychiatric and behavioral health care. This initial data gathering survey should be considered active through September 15, 2010.

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