Abstract: Background Emergency departments across the country have challenges transferring patients to a psychiatric hospital. Patients routinely board for days waiting transfer. Unfortunately, patients on publicly insurance/self-pay transfer at much lower rates than those with privately funded insurance plans
Despite EMTALA law prohibiting outside facilities from barring admissions based on ability to pay, patients in our region with public insurance/self-pay are 6 times less likely to transfer to an outside hospital compared to those with private insurance. This reflects the compound marginalization of an already stigmatized patient population. Methods: A quality improvement team of nurses, EM staff, a CL-APRN and CL-psychiatrists worked towards an equitable rate of transfer to outside hospitals regardless of insurance status. Some of our interventions included blinding insurance information to outside hospitals and empowering staff with assertive communication to outside facilities when EMTALA violations may occur. We now regularly report EMTALA violations. We began open collaboration with other psychiatric hospitals in the region to address these challenges.
We track successful transfers to outside hospitals of both publicly insured/self-pay patients as well as privately insured patients. We aim for equal rates of success for both groups. We track potential EMTALA violations and reports to the state when patients are denied based on insurance. Results: We rose to 30% acceptance rate of publicly insured/self-pay patients compared to 8% prior to intervention. This matches the same rate of successful transfers of private insurance patients. We've referred over 10 EMTALA violations to the state health department Future Implications Challenges in transferring publicly funded/self-pay patients to psychiatry is a universal problem. We offer a tested model which improved and equalized access to care. Discussion: Access to a psychiatric hospital from an emergency department should never be contingent upon somebody's insurance or ability to pay. We designed and tested a quality improvement project that successfully equalized transfer of boarding ED patients to psychiatric hospitals. Offering equitable care to historically marginalized groups is a core value of CL-psychiatry. This is an ongoing QI project with the support of leadership and we're eager to share our data, successes and challenges.
