While many communities propose increasing available inpatient psychiatric hospital beds as the sole answer to the boarding issue, the STCC Steering Committee has instead allocated funds to sustain and expand the existing Psychiatric Emergency Service (PES) at Nix Health. A PES provides an alternative to the emergency department for patients in need of acute psychiatric care and can provide assessment and treatment that may stabilize a majority of the crisis mental health population at this level of care, thus dramatically alleviating the demand for inpatient psychiatric beds. San Antonio’s only PES, operated by Nix Health, was in jeopardy of closure in 2018 due to changes with the federal Delivery System Reform Incentive Payment (DSRIP) program. The STCC Steering Committee allocated funding to ensure continuity of the 16-bed PES, along with funding to increase capacity by another 16-beds. As a result, the operator of the PES reports key metrics to the STCC Steering Committee, including but not limited to visits, readmissions within 30 days, unduplicated patient counts, length of stay, social determinants of health, and more.
Patients at the PES can stay up to 48 hours and are stabilized and discharged with a care plan and follow-up. If a patient’s need for additional support is identified during PES treatment, the patient may be admitted onsite to the inpatient unit. PES staff use TAVConnect to address complex crisis patients. The goal of the utilization of TAVConnect for the complex crisis population is to reduce over-utilization of crisis services by addressing the social determinants of health. Through TAVConnect, players within the continuum of care are sharing the social determinants of health responsibility to the patient. Creating this communication around patients’ needs and decreasing duplicative efforts will expand treatment capabilities for this population.
Combining the efforts of the PES and Law Enforcement Navigation allows for true decompression of the emergency departments, as medically stable emergency detained patients are navigated directly to the PES, bypassing the emergency department. This expanded PES is now working to accept direct transfers from emergency departments after patients have been medically cleared, known as “auto accept” to facilitate a streamlined patient and continuum of care experience, further decompressing local emergency departments while providing better patient care.