Nurses Association pushes legislation addressing increase in mental health patients in ED

From 2010 to 2014, the number of patients seeking mental health and substance abuse treatment increased by 24% in Massachusetts emergency departments, according to data from the Health Policy Commission.

“We have seen a sharp increase in psychiatric patients coming into the ED,” Karen Huskins, RN, of the Good Samaritan Medical Center, Brockton, Massachusetts, said in a press release. “They are not only psychiatric patients; they also have substance abuse problems.”

“Two nurses and 10 beds were tied up with patients, who needed specialized care,” Huskins added. “Their rooms needed to be cleared of potentially dangerous equipment, they needed proper medication and, in some cases, around-the-clock observation. It requires a lot of staff time and takes nurses away from other patients in the ED.”

The new data indicated a 33% increase in ED visits in the Attleboro region from 2010 to 2014.

Judith Shindul-Rothschild

Research from Judith Shindul-Rothschild, PhD, RNPC, associate professor at Boston College, showed EDs in Massachusetts hospitals significantly exceeded the number of patients a nurse can safely care for, and that patients in these hospitals wait a long time for treatment.

Patients of the University of Massachusetts Marlborough Hospital wait an average of 2 or more hours to be evaluated in the ED, according to Shindul-Rothschild.

Despite these increases, Massachusetts Gov. Charlie Baker has proposed physicians be allowed to commit patients with substance abuse issues for up to 72 hours without a court order, which may further burden EDs.

The Massachusetts Nurses Association has filed legislation addressing overcrowded EDs in the state, including:

S.1051/H.1793: An Act Relative to Creating a Pilot Program to Transfer High Acuity Behavioral Health and Dual Diagnosis Patients Away from Crowded Emergency Departments; and
S.1206/H.1958: An Act Relative to Patient Safety.

The first bill will establish a pilot program in Taunton State Hospital to transfer medically stable, high acuity behavioral health and dual diagnosis patients from overcrowded EDs until appropriate placement is found.

The second bill aims to improve patient safety by determining a limit on number of patients assigned to a nurse at one time, while providing hospitals with the ability to adjust staffing based on patient needs.

“We've seen a spike in waiting times in our ED,” Linda Condon, RN, of Morton Hospital, Taunton, Massachusetts, said in the release. “When the state closed mental health beds at Taunton State Hospital and moved them to Worcester, it did not help southeastern Massachusetts. We need more high-acuity beds like those proposed in the Taunton State Hospital pilot program, and also more long-term and transitional services. Patients are being released from short-term acute psychiatric facilities without transitional services or long-term treatment and are going right back to the ED to start the process all over again. We're also understaffed. Until we safely limit how many patients a nurse can care for at one time and increase the number of beds available, patient care is going to suffer.”