Behavioural assessment unit improves outcomes for patients with complex psychosocial needs

Area of Science:

• Emergency Medicine
• Psychiatry
• Health Services Research

Background:

• Emergency departments (EDs) often face challenges managing patients with acute behavioral disturbance.
• These patients, including those with intoxication, mental illness, or psychosocial crisis, require specialized and timely interventions.
• Existing ED models may lead to prolonged stays and increased use of restrictive measures.

Purpose of the Study:

• To evaluate the impact of a dedicated Behavioral Assessment Unit (BAU) on patient care within the ED.
• To assess whether the BAU model reduces wait times and the utilization of restrictive interventions for patients with acute behavioral disturbance.
• To determine the effectiveness of a specialized, highly resourced unit for managing complex ED presentations.

Main Methods:

• A pre-/post-intervention study design was employed.
• A dedicated six-bed Behavioral Assessment Unit (BAU) was established, co-located with the ED.
• Patient data from the BAU were compared with historical ED data from the preceding year.

Main Results:

• The BAU led to a significant decrease in wait to be seen (40 min vs 68 min) and ED length of stay (180 min vs 328 min).
• Wait times for mental health review were also reduced (117 min vs 139 min).
• There was a statistically significant reduction in the use of security codes, mechanical restraint, and therapeutic sedation for patients admitted to the BAU.

Conclusions:

• A specialized unit designed for patients requiring prolonged ED care due to mental illness and/or intoxication effectively reduces ED time and restrictive interventions.
• The Behavioral Assessment Unit (BAU) model demonstrates a successful approach to managing acute behavioral disturbance.
• This model of care is recommended for EDs serving complex patient populations presenting with behavioral crises.