case study

Eliminating Emergency Department Boarding Through the Creation of a Psychiatric ER

A hospital emergency department was receiving 700 patients with behavioral issues per month, but was failing to properly treat them and relied heavily on admitting them for costly (and often unavailable) inpatient care.

The CXNS Plan

  • Develop standards to properly assess and care for behavioral health patients
  • Address serious problems related to ER boarding
  • Create a solution that benefits the efficiency of both the emergency department and newfound psychiatric emergency services
  • Need to avoid boarding psychiatric patients in ER due to high risk for self-harm, violence and elopement
  • Need to avoid boarding psychiatric patients due to their contributions to overcrowding emergency departments which impacts care for non-psychiatric patients
  • Average dwell time for psychiatric patients decreased from 5-6 days to less than 12 hours
  • Integrated care between ED doctors and behavioral staff
  • Aligned necessary case with the right providers in a cost-effective manner

The average cost of boarding a behavioral health patient is $2,264 per stay — cost reduction due to decrease in average dwell time


A section of the emergency department was made into a secure area to accommodate patients with behavioral needs, staffed with behavioral health techs, nurses and social workers, and care was integrated with the emergency room doctors. This CXNS business plan resulted in a solution for the entire hospital system.


Overcoming Barriers to Access

Criminal Justice

Creating a Crisis Center

Facility Design

Improving Throughput and Safety in an Emergency Setting

Safety in Crisis

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