Going Mental: Elmhurst Expands Psyche ER
by Richard J. Bocklett
Mar 04, 2009 | 4064 views | 0 0 comments | 48 48 recommendations | email to a friend | print
Dr. Mark Nathanson
Dr. Mark Nathanson
The Elmhurst Hospital's Psychiatric Emergency Room (PER) facilities, located at 79-01 Broadway, will expand twofold after final approval by the New York Sstate Office of Mental Health on March 5 from the current 16-patient capacity to 30.

This is the culmination of a four-year funding and space effort that included moving the Diagnostic Clinic to another wing, leaving the first floor psychiatric and medical emergency rooms adjacent to each other while allowing patients to be treated in a more capacious and friendly environment.

The Elmhurst Hospital Center is a health care facility for mental health services with about 40 percent of its beds set aside for psychiatric patients. The staff provides emergency psychiatric assessment, evaluation, treatment, and disposition.

Over 80 percent of visits are acutely ill psychiatric patients brought in by EMS and NYPD, family, and outpatient treatment agencies and programs. A significant percent of patients also come from the Riker's Island prisons.

The PER has about 7,000 visits annually with about 75 percent of those needing hospitalization remaining at Elmhurst. From 20 to 30 patients are treated in the PER daily.

"With a growing community and increased visits, we're a very busy place around the clock," explained Eric Morales, associate executive director of Engineering and Maintenance. "The present tight area can cause safety issues for patient care, and sometimes overcrowding conditions require us to transfer patients to other medical facilities."

Factors leading to the increased volume include more alcohol and cocaine abusers, depression and suicide cases stemming from economic stress and job loss, more homeless patients, and a significant number of children sent by the schools for behavioral problems. The hospital is also expecting an upswing with the closure of nearby St. John's Hospital.

In the PER, a team of nurses, social workers, and psychiatrists assess patients to develop a comprehensive treatment plan. Then, patients may be admitted to the psychiatric inpatient service, transferred to another facility, or treated and released.

Additionally, the hospital's Department of Psychiatry’s Comprehensive Psychiatric Emergency Program (CPEP) has a full-time psychiatrist and a mobile crisis team which can remove individuals as a danger to the community or who are unable to care for themselves.

Dr. Mark Nathanson, director of CPEP for six years, commented on the PER expansion.

"When the space here gets crowded, patients display more behavioral problems and an increased stress level," he said. "More likely to be agitated, the patient may need medication or restraint. The additional space will decrease the amount of agitation, which can also lead to injuries to themselves and staff.

"Also, importantly, the new facility will allow separation of adult and child-adolescent patients," Nathanson added. "The children will have their own pleasant, day area and play room surroundings, entrance and triage area with a full-time child psychiatrist, social worker, and compliment of staff. Separation is really a safety issue because a potentially volatile adult could harm a child."

The expansion will also provide more privacy and confidentiality during patient evaluations.

"Privacy is a big issue," said Nathanson. "Now we'll have more interview rooms and separate triage facilities so patients can't listen in on others' conversations."

Along with enhanced functionality expected with the expansion, Nathanson stresses the solid operational structure of CPEP.

"We have annual staff training in crisis intervention and non-uniformed security personnel so it doesn't look like a jail to minimize patient agitation," he explained.

All of the city hospitals are attempting to treat psychiatric patients with the least amount of physical restraint as possible. A private, calming atmosphere helps in this endeavor. The Elmhurst PER, for example, has reduced restraint usage by about 400 percent over the last two years. In July of 2001 there were over 50 patients restrained per 1,000 PER visits compared with less than ten in November of 2008.

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