I work in a general hospital in the psychiatry service. Administration is thinking of closing all/some of our psych beds because they are not as profitable as others may be. Can anyone speak to experiences in the ED resulting from having psych pts. come through with nowhere to send them to or having to wait for a bed to open up in another hospital? I need hands on, real-RN experience and thanks for that!
Aug 14, '02
6 years ago, 1-2 hours to get placed. now we have held people for as long as 36 hours to get them placed. 
it kinda stinks!
me 
Aug 15, '02
Thanks for your reply. That is our concern as well. Has it been 6 years since your psych areas closed? Are you in a general hospital? How do you maintain those patients while they wait? (Your information is very helpful and much appreciated.)
Aug 15, '02
we are a hospital that never had a psych facility. however, in our system there are four psych facilities. however, it seems in the end, they are placed in the competitions facilities for some reason? oh yeah........btw it's not neccesarily because of insurance issues either.
me
Aug 15, '02
Thanks for the follow up.
Aug 16, '02
we have a psych er where they go immediately if they have no medical complaints. a provider from fast track does a PE ( labs are drawn in the psych er) when they are ready for d/c or to go up to the floor. The ones with medical complaints go to the medical area until they get medical clearance, and get immediate one to one observation by a PCT. we have had elopements from the medical area, 2 in fact that i can think of recently, one of those will be a lawsuit i am sure.
Aug 16, '02
Howdy yall
from deep in the heat of texas
Were lucky here, for a simple clearance for committment just 1 to 2 hours. For someone who needs observation depends, if its just a few hours than they go to the ED obs unit, longer than that they go nupstairs.
doo wah ditty
Aug 21, '02
In the midwest, psych beds are closing fast - our city/are of 250,000, has 20 in-pt pysch beds - thats it!!! Everything else is closed down. It has virtually ground our ER to a halt at times - psych pts are just so time-consuming and time is a very tight commodity.
Aug 22, '02
Thanks very much for your reply. I'm hoping to get more real-world feedback from ED RNs so I can share it with administration before they take this same step.
Aug 22, '02
While in school I had clinical in an ER in Georgia. I was surprised to see how the staff and physicians reacted to psych pt's. The doctor was freaking out and wanted the patient out of the ER ASAP. Control was a major problem. Not many nurses felt comfortable working with them. It is not a quick fix except with Haldol temporarily. I am talking about Schitzophrenia and Bipolar patients. The ER sees many psych patinets but minor ones. We had an aggressive schitzo patient that scared everyone. I think your state needs to make sure ER nurses are well qualified to deal with aggressive sitiuations and therapeutic communication.
Aug 23, '02
We wait anywhere from 8 to 24hrs to get psych pt's placed. We are a community hospital with no psych, no 24hr social workers, no oncall psych MD, and no secure room and 1 security guard per shift. Alot of ours are drug and alcohol problems too and only certain facilities deal with that.
The largest psych hospital with the most beds and most outpt programs and one of the few that did drug & alcohol just closed it's doors. It will be very interesting to see where these people will go now and the safety issues of keeping them in small ERS ill-equiped for psych. I'm not looking forward to it.
Aug 24, '02
Howdy yall
from deep in the heat of texas
From what I have been reading, you will be seeing more closures of psych beds. Things will only get worse.
doo wah ditty
Sep 8, '02
I work at a state Mental Institution, and in the past year, our patient census has been cut in half, by our state budget..... where these patients are going...? You tell me. If they were suffering from any other illness, I'm sure their beds wouldn't be eliminated, and their funding cut like this....
Do I sound bitter.....?
Aug 14, '02Occupation: RN Specialty: ER, PACU, OR ; Joined: Dec '98; Posts: 2,120; Likes: 286 years ago, 1-2 hours to get placed. now we have held people for as long as 36 hours to get them placed.
Aug 15, '02Joined: Aug '02; Posts: 11Thanks for your reply. That is our concern as well. Has it been 6 years since your psych areas closed? Are you in a general hospital? How do you maintain those patients while they wait? (Your information is very helpful and much appreciated.)
Aug 21, '02Occupation: allnurses Asst Community Manager, APRN Specialty: 25 year(s) of experience in Nephrology, Cardiology, ER, ICU ; From: US ; Joined: Apr '00; Posts: 53,367; Likes: 26,198In the midwest, psych beds are closing fast - our city/are of 250,000, has 20 in-pt pysch beds - thats it!!! Everything else is closed down. It has virtually ground our ER to a halt at times - psych pts are just so time-consuming and time is a very tight commodity.
