We need more beds now!
Also: EPs looking for a way out; the pharmacy will see you now; "do you remember that patient?"; and hospitals trying to climb out of a hole
Top of the week
Psychiatric bed crisis needs help now!
In EDs across America, psychiatric patients are being boarded because there are no beds available for them.
In 2020 there were 668 psychiatric hospitals in the US. About half are for-profit and the other half are a combination of private non-profit and public funded. However, these numbers alone do not clearly communicate the resources available.
For example, there are different levels of psychiatric care provided by facilities, and there is no standardized best practice of deciding exactly what type of psychiatric bed a patient needs. So, if you are trying to transfer a psychiatric patient from your ED, there may be a vacant psychiatric bed available in a different facility, but your patient may not get it. Sometimes ED psychiatric patients can be extremely violent and the prospective gaining facility may decide they cannot care for such a patient. You will be boarding that patient for an extended period. Of course, this adds additional stress to your nursing staff, and even increases risk of injury.
How did we get here? That’s a story onto itself, but a 2012 report found that from 2005 to 2010 there was 14% decrease in psychiatric beds in the US. A 2021 study found that for every 100,000 people, there should be about 34 in-patient psychiatric beds. The same study found that about 32% of states were not meeting this standard.
In-patient psychiatric beds are expensive, and many private facilities will only accept private pay. Many low-income psychiatric patients can only rely on Medicaid to pay for healthcare, but there are restrictions in billing Medicaid for long-term psychiatric care. So, these patients end up in the ED.
This article discusses this growing problem. Many of you have experienced episodes like the ones discussed in this article. My department has also boarded psychiatric pediatric patients for very lengthy extended periods of time ranging from days to even weeks. More financial resources will have to be invested in creating more in-patient psychiatric beds, providing psychiatric specialists in the ED, and providing better out-patient community resources.
Emergency Medicine
A recent 2022 Emergency Medicine News survey found that a considerable number of emergency physicians are considering leaving the ED. A notable factor was their negative experience during the Covid pandemic. However, as impactful as the effects of the pandemic were, other provoking factors for EP dissatisfaction were identified.
About 50% of full time EPs were not satisfied with pay. In addition, the negative impact of ED nursing shortages was significant. Also, EPs felt that there was increased pressure to see more patients and make more money for the employer.
There is no argument that EPs are facing increasingly difficult challenges in this specialty. They are being asked to do more with less and incur more liability. EM NPs and PAs encounter nearly all of the same stressors. EM provider staffing groups will have to enlist a sufficient number of EM providers who are appropriately matched for the specific needs of a given ED. Staffing groups will have to address improvements in provider pay. They will have to engage hospital administrations more frequently and robustly to advocate for ED providers.
House of Medicine
Pharmacies attracting more convenient care patients
It appears that an increasing number of younger patients are prioritizing convenience when seeking care for minor medical conditions. They are gravitating to pharmacies and being cared for by NPs, PAs, and pharmacists. At a time when many patients are told there will be a 2 week or more wait for a simple primary care visit, pharmacy clinics seem to be increasing access to care.
Your exposure to a lawsuit may be expanding
In Maine a new legislative bill is proposing delaying the “start” time of how long a patient has to file a medical malpractice claim. Total length of time afforded to patients varies by states, but most states allow for about 2-3 years. It’s important that you are aware of your state’s statute of limitations, and that you understand the extent of the coverage your current policy provides.
Hospitals, health systems, and more
Hospital layoffs continue
2022 was a very tough financial year for hospitals in the US. Hospitals are seeing a little improvement in profits this year, but industry challenges still exist. Consider the six latest healthcare bankruptcies. For now, it appears that layoffs will continue in a number of markets. In addition, some hospitals will continue to cut services, and close departments all together. Some health systems were even found to have developed policies to deny nonemergency care to indebted patients.
The Good Stuff
Meet Cindi Warburton, an NP and Advanced Practice Provider - Program Manager for a health system. She is tackling the provider gap with capable NPs and PAs. She’s an experienced provider who is showing leadership in improving access to care.
Read about a Wayne Student University PA student who jumped into action to provide lifesaving care to a needy patient. Great job, Alex!
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