Creating Flexible Treatment Spaces

Improving patient safety during behavioral health emergencies

• By Siva Davuluri
• June 01, 2021

Teaching hospitals and emergency medicine residency programs face a variety of challenges in treating behavioral health patients. Chief among them is creating a safe environment that protects patients and staff.

This is an increasingly urgent issue as healthcare systems continue to deal with a sharp rise in behavioral health-related patients. According to recent data from the National Alliance on Mental Illness, one in eight emergency room visits by U.S. adults involves mental illness or substance use disorders, with an estimated 12 million visits per year.

Amid the pandemic, those numbers have only increased. The Center for Disease Control (CDC) reported that in June 2020, rates of anxiety were approximately three times higher and depression cases were approximately four times higher than the year prior. According to the report, younger adults, racial/ethnic minorities, essential workers and unpaid adult caregivers are disproportionately aflicted with worse mental health outcomes, increased substance use and elevated suicidal thoughts.

Behavioral health education in institutions across America provides future practitioners with well-rounded training to treat these kinds of issues. But for residents in emergency departments, the resources are fewer and further between. That’s because emergency medicine wasn’t designed to specialize in behavioral health issues, and yet, due to a number of converging societal factors, emergency rooms have become treatment facilities for many patients who have nowhere else to turn.

A report by the Agency for Healthcare Research and Quality revealed that emergency room visits related to mental health and substance-use issues increased more than 44 percent from 2007-2013, with visits from patients suffering suicidal thoughts growing by a devastating nearly 415 percent. Aside from the lack of psychiatric training for emergency medicine doctors and residents, however, is the compounding issue of the facilities themselves: most emergency departments are not physically equipped to deal with behavioral health emergencies the way that inpatient behavioral health facilities are set up.

That is even more concerning when you consider the trend of emergency department “boarding”—where behavioral health patients remain in emergency care rooms a er being admitted, waiting to be transferred to an inpatient unit. According to one study, behavioral health patients spend 42% more time waiting in the emergency room compared to other patients; their wait times average out at more than 11 hours. That all adds up for patients, doctors and residents and increases safety risks for everyone.

Equipping Facilities for Safety

Psychiatric cross training is slowly beginning to work its way into emergency departments and emergency medicine residency programs. But facility managers and safety committees in teaching hospitals also have a responsibility in protecting occupants by ensuring facilities are up to date with the latest building safety technologies and trends.

Some industrial rolling door manufacturers are introducing new products into the market specifically engineered to make spaces like emergency departments safer and more secure for patients and staffalike, creating flexible spaces that can transition seamlessly from behavioral health to emergency medicine areas.

Advanced new ligature-resistant counter doors can deploy with the mere press of a button, converting standard exam, diagnostic or emergency care rooms and treatment bays into safe spaces for patients suffering an acute behavioral health issue. These doors can cover cabinetry, pharmaceuticals storage, countertops, computers, medical equipment and other potential ligature points that can be used for self-harm or against medical staff, all with a single rolling steel door. The doors can be finished to match the surrounding, or designer can pick a color that provides calming ambience for patients while waiting to be seen.

Constructed of steel or aluminum, some products offer impactand tamper-resistance while meeting ASHRAE/Facility Guidelines Institute (FGI) recommendations for exam rooms. The key for behavioral applications is to ensure fasteners are concealed and have no grab points or pinch points, eliminating potential points of ligature.

“This technology offers staff the flexibility to change rooms around with the functionality to treat mental and physical ailments in the same space,” said Nicole Vivalda, product manager at CornellCookson. “And, from a training perspective, it allows students and residents the opportunity to see both types of treatments for patients coming into the hospital, as well as facility enhancements that can keep people safe during behavioral health emergencies.”

The systems also offer the added safety benefit of a closure apparatus mounted on the wall outside of the patient room. “By placing the control panel outside of the room, staff are able to operate the door without being in the space,” Vivalda said. “This provides the best level of security for both the patient and the provider.”

Budget-friendly Solutions

Though safety and security are always top of mind, the lean budgets on which many emergency departments and emergency medicine training facilities operate mean large-scale construction projects and the facility downtime associated with them are simply not possible.

The technology behind the engineering of ligature-resistant counter doors extends to installation as well. Many products are designed with the flexibility to be easily retrofitted into existing spaces without the need for extensive or time-consuming renovations.

Many doors are affixed with sturdy and simple-to-install structural tubes, which means they don’t require the backing of studs or a support wall. The tubes can simply be put into place and drywall can be built around the door guides for a fast, seamless installation while emergency departments remain in operation. This also helps with existing space constraints in most emergency department rooms as doors can be added with a very narrow footprint.

Limiting Liability

Managing behavioral health risks in emergency departments and emergency medicine training facilities is tricky. Beyond the dangers to patients and staff, untrained staff and ill-equipped emergency rooms can also leave medical facilities open to potential liability risks.

Adequate training for doctors, nurses, residents and med students is part of the equation. But implementing measures like anti-ligature rolling doors offer an added safety measure that creates more secure facilities.

“These products are an easy solution to a very serious problem,” Vivalda said. “They can prevent hospitals from having to build a separate wing for mental and behavioral health patients. Exam rooms can be easily transitioned back and forth with the touch of a button. It doesn’t get much easier than that.”

Securing for Future Care

Because many emergency departments and emergency medical training facilities are not built for the special requirements involved in behavioral healthcare, there is a lack of resources for treating patients in a safe and secure environment.

Facility managers can turn to door manufacturers to help with creative new ways to turn emergency care rooms into behavioral health-friendly spaces. This can also save healthcare providers money and resources while providing needed security for doctors, nurses, residents and patients.

This article originally appeared in the May / June 2021 issue of Campus Security Today.