Effectiveness of a Novel Emergency Department Psychiatric Care Model in Reducing Length of Stay.

Abstract

Patients with psychiatric emergencies experience emergency department (ED) lengths of stay 3 times longer than those with nonpsychiatric complaints, contributing to crowding and inefficiency. We evaluated whether a novel staffing model, the Psychiatric Model of Care, reduced length of stay for these patients. This quality improvement study used an interrupted time series design at a tertiary, urban academic medical center to analyze deidentified ED encounters from January 1, 2023, to December 31, 2024, spanning preimplementation, roll-out, and postimplementation periods. The model embedded psychiatry-specialized nurse practitioners and support staff in the ED 24/7 for assessment, crisis stabilization, and disposition planning. Adults with a psychiatric chief complaint, psychiatry consultation, or an involuntary psychiatric hold were included. The primary outcome was ED length of stay (time from rooming to final disposition) analyzed using segmented quantile regression. Among 5,222 encounters, median ED length of stay decreased from 8.35 hours (IQR 3.76-18.35 hours) to 5.61 hours (IQR 3.00-10.24 hours), with an adjusted median difference of -1.64 hours (95% confidence interval [CI] -3.15 to -0.13). The largest reductions occurred for patients on 72-hour (-9.66 hours; 95% CI -12.92 to -6.40) and 14-day (-18.80 hours; 95% CI -52.76 to -10.67) involuntary holds, and those transferred to psychiatric facilities (-4.80 hours; 95% CI -10.46 to -1.88). Differences were not significant for patients without holds or those discharged or admitted. The Psychiatric Model of Care significantly reduced ED length of stay for patients with psychiatric emergencies, suggesting a promising approach to improve patient flow and care delivery.