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

Patients with psychiatric emergencies experience emergency department lengths of stay three times longer than those with non-psychiatric complaints, contributing to emergency department crowding, decreased inefficiency, and reduced patient care satisfaction. Care delivery models addressing psychiatric emergencies are urgently needed. This study evaluated whether implementation of a novel emergency department care delivery model, The Psychiatric Model of Care, was associated with reductions in length of stay for patients presenting with psychiatric emergencies.

We conducted a quasi-experimental interrupted time series analysis of de-identified emergency department encounters at an urban, tertiary medical center with approximately 40,000 annual visits. The study spanned from January 1, 2023, to December 31, 2024, comprising pre-implementation, roll-out, and post-implementation periods. The model embedded psychiatry nurse practitioners and support staff in the emergency department 24/7 for rapid assessment, crisis stabilization, and disposition planning. We included adult emergency department encounters with either a psychiatric chief complaint, a psychiatry consultation, or an involuntary psychiatric hold placement. The primary outcome was emergency department length of stay, defined as the time from rooming to final disposition.

Among the 5,222 included encounters (median (IQR) age, 40 (31-54) years; 59% male), 2,651 occurred during the pre-implementation period, 690 during the roll-out period, and 1,881 during the post-implementation period. The model’s implementation was associated with a reduction in mean emergency department length of stay by 5.45 hours (95% CI: 5.00 to 5.89). For patients on 72-hour and 14-day involuntary holds, length of stay significantly decreased by 4.14 hours (95% CI: 3.93 to 4.36) and 6.08 hours (95% confidence interval: 5.38 to 6.78). Significant reductions were seen across all dispositions: discharged (4.98 hours; 95% CI: 4.45 to 5.50), admitted (7.16 hours; 95% CI: 6.19 to 8.13), and transferred to a psychiatric facility (5.67 hours; 95% CI: 4.71 to 6.64).

Implementation of this psychiatric care model significantly reduced emergency department length of stay for patients with psychiatric emergencies, suggesting a promising approach to improve patient flow and care delivery.