BACKGROUND: Mental health patients wait lengthy periods in emergency departments for disposition. This delay is secondary to the process of medical clearance and then placement in an appropriate psychiatric specialty center. ACEP clinical policy questions the necessity of laboratory investigation for medical clearance and favors history and physical exam to determine safe disposition to mental health facilities. This manuscript explores if specially trained paramedics can effectively employ triage algorithms to determine proper disposition of patients suffering an acute mental health crisis in a 9-1-1 system. METHODS: Six paramedics working for AMR in Stanislaus County, California underwent 180 hours of specialized training to become Mobile Integrated Healthcare Paramedics (MIHPs). Their training detailed the use of two algorithms designed to identify patients that require evaluation in an emergency department versus those that can be triaged directly to a licensed mental health facility. Patients aged 18-59 with a suspected mental health crisis who are encountered via the 9-1-1 system, law enforcement or who walk in to the mental health facility for treatment were eligible. All patients in the study were evaluated with the well person algorithm (WPA). Those that passed the WPA were evaluated using the mental health clearance algorithm (MCHA). MIHPs directed patients to either the ED or the mental health facility based upon the evaluation results of the WPA and MHCA. RESULTS: 1006 patients were evaluated between September 2015 and December 2017. 404 patients failed one or more components of the WPA or MHCA. 326 patients passed both the WPA and the MHCA, but were ultimately transported to a local emergency department, most often because of lack of available psychiatric beds in the community. 276 patients were transported directly to a psychiatric facility. Of these, 10 returned to the emergency department within 6 hours, but none of the 10 were admitted for a previously unidentified medical or traumatic condition. CONCLUSION: Specially trained paramedics can effectively employ triage algorithms to screen and select patients experiencing an acute mental health crisis for transport directly to psychiatric treatment facilities.
BACKGROUND: Mental health patients wait lengthy periods in emergency departments for disposition. This delay is secondary to the process of medical clearance and then placement in an appropriate psychiatric specialty center. ACEP clinical policy questions the necessity of laboratory investigation for medical clearance and favors history and physical exam to determine safe disposition to mental health facilities. This manuscript explores if specially trained paramedics can effectively employ triage algorithms to determine proper disposition of patients suffering an acute mental health crisis in a 9-1-1 system. METHODS: Six paramedics working for AMR in Stanislaus County, California underwent 180 hours of specialized training to become Mobile Integrated Healthcare Paramedics (MIHPs). Their training detailed the use of two algorithms designed to identify patients that require evaluation in an emergency department versus those that can be triaged directly to a licensed mental health facility. Patients aged 18-59 with a suspected mental health crisis who are encountered via the 9-1-1 system, law enforcement or who walk in to the mental health facility for treatment were eligible. All patients in the study were evaluated with the well person algorithm (WPA). Those that passed the WPA were evaluated using the mental health clearance algorithm (MCHA). MIHPs directed patients to either the ED or the mental health facility based upon the evaluation results of the WPA and MHCA. RESULTS: 1006 patients were evaluated between September 2015 and December 2017. 404 patients failed one or more components of the WPA or MHCA. 326 patients passed both the WPA and the MHCA, but were ultimately transported to a local emergency department, most often because of lack of available psychiatric beds in the community. 276 patients were transported directly to a psychiatric facility. Of these, 10 returned to the emergency department within 6 hours, but none of the 10 were admitted for a previously unidentified medical or traumatic condition. CONCLUSION: Specially trained paramedics can effectively employ triage algorithms to screen and select patients experiencing an acute mental health crisis for transport directly to psychiatric treatment facilities.
Entities:
Keywords:
community paramedic; medical clearance; mental health; mobile integrated healthcare
Authors: Tony W Thrasher; Martha Rolli; Robert S Redwood; Michael J Peterson; John Schneider; Lisa Maurer; Michael D Repplinger Journal: WMJ Date: 2019-12