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Breaking Down Barriers to Patient Flow Across a Growing Psychiatric
Service Line

The NewYork-Presbyterian psychiatric service line is one of the largest inpatient psychiatric providers in the United States, with more than 550 beds spanning 6 locations.

Historically, access to beds had not been optimized or coordinated. Staff in the emergency departments and medical floors were spending exorbitant amounts of time locating beds for individuals who needed psychiatric treatment. The goal of this initiative was to find a single solution that could be implemented across the entire enterprise.

NewYork-Presbyterian launched a Psychiatry Inpatient Access Center in early 2018, creating an efficient and centralized process for bed placement horizontally across the region. Here are its features:

Opportunity for Improvement:

• Identify and breakdown barriers to admission flow across the service line
• Maximize throughput and capacity
• Utilize technology
• Increase cross campus collaboration
• Decrease Lengths of Stay (LOS) in emergency departments and medical units once medically stabilized

Objectives:

• Reduce the bottle-neck effect in emergency departments and inherent delays in locating psychiatric beds
• Design and implement a new enterprise wide approach toward admissions related to individuals requiring inpatient psychiatric hospitalization
• Creation of a bed flow management system, which will result in increased throughput, shared acuity, and positive patient experience

To address these issues, a central Psychiatry Inpatient Access Center was created to manage all psychiatric beds in the system and create a single point of contact for those in need of an admission.

• Timeline – brought 550 beds across 6 hospitals online over 12 month period
• Functionalities –
  • Patient placement through use of a multifaceted assessment process
  • Streamline patient flow
  • Streamline patient financial clearance
  • Oversight of internal and external admission into inpatient psychiatry beds
  • Improve the patient experience by significantly reducing LOS in Emergency Departments

Psychiatric Access Center: Triage and Placement Process

The following criteria are taken into account when identifying the right bed for each patient:

• Specialty needs – i.e., Eating Disorders, Geriatric, addiction recovery, etc.
• Med/Psych needs
• Acuity
• Geography
• Patient/Family preference
• Bed availability
• Patient insurance
• Urgency for hospital Emergency Departments, CPEPs, and LOS on medical floors

Health System Outcomes

• Increased patient throughput in emergency departments, with decreased LOS
• Decreased open beds
• Increased transparency
• Stabilized acuity across a larger pool of beds
• Improved financial outcomes
• Leveraged Information Technology solution and data to drive quality, throughput, and financial performance

Results:  Optimization of access for NYP consumers

• Decreased LOS in CPEPs
• Transfers to Gracie Square Hospital (part of the NYP Psych Service Line) increased from 65% to 84%.
• Transfers to NYP Brooklyn Methodist Hospital increased from 2% to 31%.
• Patients are placed in beds that meet their needs and preferences (whenever possible).
• Staff in both the Emergency Departments and medical floors have a single number to call to place an individual in need of psychiatric inpatient treatment, resulting in increased patient and staff satisfaction.

For more information, please visit www.nyp.org/psychiatry.