ER physicians begging lawmakers to help with overcrowded emergency departments

Mental health patients are most affected, kept waiting the longest

SAN ANTONIO – The reasons for crowded emergency rooms are complicated, but one main issue is called patient boarding.

Patient boarding is where admitted patients are held in the emergency department when there are no inpatient beds available.

Those inpatient beds are sometimes filled with patients who need to be getting care elsewhere.

Often, it’s mental health patients who are waiting on referrals or transfers to other facilities that are also full.

Many patients with mental health emergencies have limited options for acute or sustained care beyond the emergency department.

On average, patients with mental health care needs wait three times longer for care than other patients, according to the American College of Emergency Physicians.

“I have colleagues telling me they have patients spending weeks in the emergency department waiting to get somewhere,” said Dr. Ralph Riviello, University Health System Emergency Medicine Chair.

Riviello said it’s often hardest for smaller or rural communities with fewer hospitals and shorter staff. However, he said it’s still a big issue in San Antonio.

“In the region, it’s probably an everyday occurrence across multiple hospitals, health systems,” he said.

Riviello said while San Antonio has these issues, the Alamo City has far more resources and programs established than other areas.

Hospitals across Bexar County have a central tracking system that looks at all the open beds available for patients, so they can be sent to best location.

The service, MEDCOM, is operated through the Southwest Texas Regional Advisory Council, or STRAC.

“We make one phone call to MEDCOM, we give them the information on the patient, and they put out the requests to all of the psychiatric hospitals to see if somebody can take a patient,” Riviello said.

That way, mental health patients who need specialized care don’t end up waiting in emergency rooms as their conditions worsen.

The Bexar County area has also engaged its law enforcement partners.

“For years, we have a program where law enforcement can respond to the scene of somebody having a behavioral health mental health crisis, and they could determine if that patient needs to go to the emergency room, or they could be directed right to the mental health facility, psychiatric hospital for evaluation and treatment,” Riviello said.

He said it diverts hundreds of patients away from local emergency rooms.

“And it’s been proven safe. We haven’t missed things. People with medical problems don’t erroneously wind up at the wrong place, and we have a process to discuss those cases if they should happen,” Riviello said.

Creative solutions like these require money.

That’s why the American College of Emergency Physicians is demanding nationwide funding.

They sent a letter to President Joe Biden and other lawmakers explaining the crisis in detail and asking for help.

The letter included stories from more than 140 emergency physicians across the country describing treating patients in hallways or waiting rooms.

Many of the stories detail patients dying in waiting rooms or triage areas.

Doctors with ACEP are now begging lawmakers to pass the bipartisan Improving Mental Health Access from the Emergency Department Act.

The legislation would give hospitals critical funding to implement and expand the programs that work best for them.

“Using tele psychiatry services, whether it’s creating other linkages to community partners or to substance abuse treatment programs,” Riviello said.

Riviello said each hospital has different needs and need the funding to relieve understaffed and overcrowded emergency departments.

While Riviello said creating more inpatient beds is probably necessary, he said preventing the need for those beds should probably be the priority.

“Creating outpatient networks, psychiatrists, psychologists, other mental health professionals in the community that could actually see patients as an outpatient, I think would help,” he said.

Riviello thinks that would also help decompress psychiatric facilities.

“Because then you’ll have a place to refer patients to for ongoing care instead of that episodic emergency admission or ED visit,” he said.

The ACEP is also urging the Biden Administration to convene a summit of stakeholders to address this crisis, and supports the bipartisan Congressional call for the Department of Health and Human Services to establish a boarding task force with broad stakeholder representation so that immediate and long-term solutions can be identified and implemented.

About the Authors:

Courtney Friedman is a KSAT anchor and reporter. She has an ongoing series called Loving in Fear, confronting Bexar County’s domestic violence epidemic. She's also covered Hurricane Harvey, the shootings in Sutherland Springs and Santa Fe, and tornadoes throughout Texas. She’s a California native and proud Longhorn who loves calling SA home.

Sal Salazar is a photojournalist at KSAT 12. Before coming to KSAT in 1998, he worked at the Fox affiliate in San Antonio. Sal started off his career back in 1995 for the ABC Affiliate in Lubbock and has covered many high-profile news events since. In his free time, he enjoys spending time at home, gaming and loves traveling with his wife.