In Year One, Psych-ED Model of Care Delivers Results for All

In 2024, the emergency medical team at UCSF Helen Diller Medical Center at Parnassus Heights (Parnassus) established a new model for psychiatric emergency care in partnership with the UCSF Department of Psychiatry. According to Maria Raven, MD, MPH, MS, vice chair and chief of emergency medicine at UCSF Medical Center, the model has been an unequivocal success.

“It has not only reduced overall length of stay by 33 percent — more than initially projected — but also reduced unnecessary hospitalizations, improved the flow in the ED [emergency department], reduced workplace violence and improved the experience and care for these patients,” she says.

Collaboration and Support Address a Critical Need

According to a 2023 article in Psychiatry Online, increasing numbers of patients are seeking care for psychiatric illness in EDs and these patients occupy more time than non-psychiatric patients.

The ED at Parnassus knows the challenges firsthand. “These are often extremely sick patients in crisis,” says Raven. “They might be psychotic, depressed or struggling with substance use disorders, and the ED is not a therapeutic environment for them to begin with.”

Moreover, before establishing the model, patients who needed psychiatric care might experience long waits for psychiatric consults. At times, the waits escalated these patients’ agitation, necessitating physical or chemical restraints. If, in turn, patients became too sleepy to respond to a provider, care could be further delayed.

In response, the department collaborated with the UCSF Department of Psychiatry to forge a vision for helping these patients. They presented it to UCSF Health leadership, who responded with their support.

Today, psychiatric nurse practitioners, psychiatric registered nurses and psychiatric hospital assistants provide full-time coverage in the ED, with attending psychiatrists on call across all shifts. These teams focus on rapid assessment, crisis intervention, stabilization and efficient transfer of those who require inpatient care.

Specifically, as soon as patients with a psychiatric condition enter the ED, there is a trained psychiatric provider there to help assess them alongside the medical team. If these patients are appropriate for discharge, the providers are also intimately aware of the resources that offer treatment in the community and, therefore, can effectively coordinate care.

Measurable Improvements

The difference has been palpable and measurable.

“This model has reduced length-of-stay for patients discharged with a psychiatric condition from nearly 17.5 hours to 11.5 hours, reduced workplace violence episodes and violence restraints, reduced costs [and] improved provider satisfaction.”

Every single metric has been positive,” says Jahan Fahimi, MD, MPH, executive medical director of UCSF Medical Center’s adult emergency department.

And because the new model has significantly reduced the need to admit many of these patients to the hospital by appropriately and efficiently treating and discharging them, both ED and inpatient beds that used to be occupied by those with psychiatric conditions have now become available.

“It’s so much more efficient and humane,” says Raven. “Not just for these patients, whose care happens sooner and who are with us for less time, but it also frees up our ability to address all of our patients in a more timely way.”