Reducing Behavioral and Mental Health Emergency Department Visits and Admissions

Area of Science:

• Adolescent Health
• Quality Improvement Science
• Behavioral and Mental Health Care

Background:

• National rise in pediatric emergency department (ED) visits and admissions for behavioral and mental health (BMH) concerns.
• These encounters can be traumatic and have adverse consequences for patients and families.
• Need to reduce excess ED utilization for BMH issues in adolescent primary care.

Purpose of the Study:

• To decrease the BMH ED visit rate from 7.9 to 6.0 per 1000 patients per month.
• To decrease the BMH admission rate from 4.5 to 3.0 per 1000 patients per month.
• To reduce excess ED visits and hospital admissions for adolescents with BMH concerns at an urban primary care clinic.

Main Methods:

• Quality improvement (QI) initiative conducted from 2019 to 2025.
• Population: Patients aged 12-19 years at a Teen Health Center.
• Interventions focused on 7 key drivers including staff, resources, triage, screening, care coordination, follow-up, and community outreach.

Main Results:

• BMH ED visits decreased by 25% (from 7.9 to 5.9 per 1000 patients/month).
• BMH admissions decreased by 58% (from 4.5 to 1.9 per 1000 patients/month).
• Resulted in approximately 10 fewer ED visits and 11 fewer admissions per month for BMH concerns.

Conclusions:

• Collaborative primary care models incorporating QI can improve adolescent BMH care.
• Successful reduction in ED visits and hospital admissions for BMH concerns.
• Demonstrates the effectiveness of a multi-faceted QI approach in a primary care setting.