How WellSpan Cleared Out Its ERs By Increasing Behavioral Health Services

Most behavioral health patients do not need to receive care in hospital emergency departments, the chief physician executive of WellSpan Health says.

By offering a wide spectrum of mental health services, WellSpan Health has been able to reduce the number of behavioral health patients seeking care in the health system's emergency rooms.

Crowding at emergency rooms has become a national problem. According to CMS data, the median wait time for patients in emergency rooms has increased from 2 hours, 18 minutes in 2014 to 2 hours, 40 minutes in 2022. The average overall length of stay for emergency room patients increased from 184 minutes in 2019 to 205 minutes in 2022, according to the Emergency Department Benchmarking Alliance.

WellSpan has embraced providing behavioral health services as a core element of the health system's mission, says Anthony Aquilina, DO, executive vice president and chief physician executive.

Pictured: Anthony Aquilina, DO, executive vice president and chief physician executive at WellSpan Health. Photo courtesy of WellSpan.

"WellSpan is the 13^th largest provider of behavioral health services as a health system in the United States," he says. "It is a significant part of what we do. We certainly provide more behavioral health services to the people of south-central Pennsylvania than any other health system around us."

WellSpan offers a range of behavioral health services, including inpatient services, intensive outpatient programs, partial hospitalization programs, telemedicine, behavioral health specialists embedded in emergency departments, and residential care. In the spring of 2021, the health system launched an innovative behavioral health clinic, the Specialized Treatment and Recovery Team (START).

Offering a plethora of behavioral health services has helped reduce the number of behavioral health patients seeking care in WellSpan's emergency rooms. From January 2023 to January 2024, the number of patients seeking behavioral health care in the health system's emergency departments decreased 50%.

Most behavioral health patients do not need to be in emergency rooms, Aquilina says.

"Traditionally, these patients have gone to an ER or have waited months to see a behavioral health provider," he says. "There must be access to services somewhere in between those extremes. That is why we have things like our START program and other options as well. As a chief physician executive, I know our health system thrives when we deliver great care. The best care is delivered to patients at the right place at the right time."

In addition to contributing to emergency department crowding, there are negative consequences for behavioral health patients seeking care in emergency rooms, including a suboptimal patient experience, Aquilina says.

"The main drawback is if you go to an emergency room there is a triage process, and if you are not as sick as someone else you have to wait for care," he says.

Increasing access to behavioral health services

The START program at WellSpan has increased access to multidisciplinary behavioral health services.

The START clinic offers same-day and next-day appointments for people who need behavioral health services. The clinic is open 8 a.m. to 8 p.m. Monday through Thursday and 8 a.m. to 4 p.m. on Fridays. There are plans to have the clinic open on Saturdays.

The START clinic is focused on providing rapid access and stabilization, says Mitchell Crawford, DO, medical director of addiction services at WellSpan and medical director of the START program.

"It is not the long-term home for everyone, and it is not everything for everyone, but it is a place for patients who need immediate help and a place where patients can get stabilized until they can get to a setting that is more appropriate for longer-term care," he says.

The START clinic has a team-based approach to care, Crawford says.

"I serve as the medical director of the clinic, and we have two nurses, clinical leadership, social service specialists, crisis management specialists, peer specialists, and therapists for mental health and treatment of addiction," he says.

START has purposely designed care not to be paternalistic, Crawford says.

"We do not want to say, 'I'm the doctor. I know what is best for you. Here is your treatment plan for the diagnosis I gave you. Take this medicine, and I'll see you in two weeks,'" he says. "With that kind of approach, you do not hear the participant. You do not establish an alliance with the participant. They would take their treatment plan and prescription, then put them in a trash can on their way out the door. Then we would not see them again, and they would decompensate and end up in one of our emergency departments."

Crawford says START staff members ask program participants—they are not called patients—a key question: What is most important to you right now and how can we help? START clinicians provide participants with medical care, but if a social need is most important to a participant that gets addressed as well.

A program participant may be going through a divorce and have worries about eviction and putting food on the table, Crawford says.

"They have a hierarchy of needs beyond their mental health condition, which I offer a treatment plan for. But I also pull in our social services specialist, who is really the caregiver that the participant needs to talk to in that moment," he says.