Case study · ED telepsychiatry, health system
Gundersen Health System’s six emergency departments stopped making psychiatric decisions without a specialist.
Six Wisconsin EDs added 24/7 virtual psychiatric assessment and placement. Before PMC, clinicians and local law enforcement were making behavioral health care decisions without specialist support. That changed on day one.
Before
What emergency medicine training does not cover
Gundersen Health System, now part of Emplify Health, consistently ranks among the top critical access hospital systems in the country. That ranking reflects emergency medicine performance, not psychiatric coverage. Six Wisconsin EDs operated with physicians and nurses trained for emergency care, not behavioral health crisis assessment.
Behavioral health patients require longer evaluations, specialized care and, in many cases, placement in an inpatient psychiatric unit. Discharging them safely means coordinating social services, outpatient providers, housing support and family members. Before, Gundersen’s clinicians and local law enforcement were making those calls without a mental health specialist available.
Prior to implementing PMC in our emergency departments, our clinicians and local law enforcement were having to make difficult care decisions without the guidance of a mental health specialist. So we were looking for the ability to immediately reach a psychiatric specialist for guidance and to help us develop a plan so behavioral health patients could safely leave the ER.
The decision
A mental health expert on call, 24 hours a day
The comparison that mattered was between a specialist available now and no specialist at all.
Six hospitals could not each hire and hold psychiatric coverage around the clock. What drew Gundersen to a partner was immediacy: a psychiatric specialist reachable at any hour, able to assess, recommend and help build a safe plan while the patient was still in the department.
The second half of the decision was placement. Emergency departments are not set up for clinical staff to spend hours calling inpatient units for a bed. A partner that owned the placement calls, and reported back on every one, took that work off the nurses on shift.
The program
What went live, and when
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Rollout across six EDs
Virtual assessment and placement go live.
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Assessment on request
PMC completes about 21 psychiatric assessments a month, responding in around 47 minutes.
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Placement, handled
About half of assessments end in an inpatient placement. PMC’s crisis managers make the calls, an average of 62 per patient, and most placements land in under 3 hours.
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The call log, shared
Gundersen reviews every placement attempt and uses that data to reorder the facilities PMC contacts first for its community.
Adoption was the quiet kind. In McCoic’s words, “with [PMC] there were no complaints. It was so smooth and our clinicians and nursing staff got the specialty support they needed.”
Results
What changed in the emergency departments
Figures from Gundersen’s reporting.
Department outcomes
- 21
- psychiatric assessments a month across the six EDs
- 47 min
- average response to a request for assessment
- 62
- placement calls per patient made by PMC, not by ED staff
Patient outcomes
- <7%
- of assessed patients returned to the ED within 30 days
- <3 h
- to an inpatient placement, in most cases
Fewer behavioral health patients leave against medical advice now that a specialist is reachable, and clinicians and officers no longer carry the disposition decision alone.
When you know a proper assessment has been completed and an appropriate plan of care has been made, it gives you peace of mind that we’re doing what’s best for our patients.
Transferable
What this looks like for your ED
If your clinicians or local law enforcement are making behavioral health disposition decisions without specialist support, PMC can provide both psychiatric assessment and placement coordination. A psychiatric specialist is available around the clock for assessment and care planning, while PMC’s crisis managers manage placement calls and report back on outcomes.
Response and placement times vary based on inpatient bed availability in your region. PMC can help you understand what the model could look like before any commitment.
Connect with our team to see what crisis coverage could look like for your organization.
