Backlog of behavioral health patients constrains Concord Hospital Emergency Department


Concord Monitor

Saturday, February 25, 2017


On a Concord Hospital Emergency Department wall, two large computer screens flash with brightly colored bar graphs, tracking the number of patients in the department at a given time.

Second-by-second, the hospital displays the flow of patients as they enter and exit, using the National Emergency Department Overcrowding Scale. On a good day, their score is around 75. But recently, that score has shot up as far as 500 – well above the scale’s “disaster” rating.

“A lot of that is wait times,” the hospital’s Emergency Department Director Anne Tyrol said.

The situation has been particularly acute for mental health patients. On Monday, a record 68 adult and pediatric patients were stuck in hospital emergency rooms around the state, waiting for a bed to open at New Hampshire Hospital – the state’s psychiatric facility. Nineteen of them were at Concord Hospital.

Some have been waiting in emergency rooms for weeks.

“That was the new state high,” CEO of Riverbend Community Mental Health in Concord Peter Evers said. “It’s not really a spike. It’s a bottleneck.”

The long wait times being felt in hospitals across the state are having a disproportionate effect on Concord Hospital due to its proximity to the state psychiatric hospital. In addition, its own existing mental health unit, nicknamed the “Yellow Pod,” has made it a destination for many behavioral health patients.

With two-thirds of the Concord Hospital Emergency Department’s beds already occupied by behavioral health patients, waiting times are increasing and staff are treating patients in the hallways and waiting rooms to try to keep the flow moving.

On a good week, Concord Hospital moves 10 behavioral health patients over to open beds at New Hampshire Hospital. Last week, they moved just two. At one point, 22 of the emergency department’s 37 beds were occupied by patients with mental health issues.

“The volume has been really high,” Director of Behavioral Health Services at Concord Hospital Camille Kennedy said.

As patients wait weeks for beds at New Hampshire Hospital, those coming into Concord’s emergency room with medical conditions such as the flu, skin infections or broken bones have sometimes waited hours before seeing a doctor.

Tyrol is quick to note wait times are still low compared to national averages but said plenty of patients aren’t happy with the wait.

“It’s not what this community is used to,” Tyrol said.

Doctors say they are seeing more patients coming in with complex medical problems who also need beds; 30 percent of those coming into the emergency department need inpatient care, which emergency room doctor Michael Lynch calls a “huge number.”

The patient backlog has been building for a while, and it’s showing no sign of letting up.

That’s creating a situation in the Concord Hospital Emergency Department that staff say is reaching crisis levels.

“It’s almost like we’re the frog boiling in the pan,” Evers said. “When the system sneezes, we catch the flu here.”

Space constraints

The Yellow Pod is a separate, six-room space for behavioral health patients. The spartan rooms contain a plastic bed platform, mattress and a television behind a plastic screen.

Staff have had to convert conventional hospital rooms into places for people waiting for a bed at New Hampshire Hospital.

“When beds are constrained like they are, you have few spaces to work in,” Lynch said.

Glancing down the hallway, it’s clear Concord Hospital staff are trying to make do, using whatever tools they have. Hallways have become hospital wings, as temporary beds are set up for overflow patients, cloth screens set in between them for limited privacy.

A paper sign taped to the first screen tells staff and patients, “Please do not use this hallway.”

“It’s usual for us to have patients in the hallways during the day,” Tyrol said. “That’s behavioral health and regular patients.”

Accommodating the backlog of behavioral health patients means staff are stretched to their limit, working overtime.

“All of my staff are working at the top of their capacity, physically and emotionally,” Tyrol said. “In order to give the best care to our patients, we have to add resources.”

Still, some are burning out and looking for other jobs that aren’t as high stress, she added.

“It’s hard for staff. None of us want to see patients wait at all,” Tyrol said.

Pressure point

The hospital has found ways to try to alleviate the pressure on the emergency room, according to Kennedy.

For instance, they’re able to move some of the children seeking behavioral health services to the hospital’s pediatric wing to get them out of the stressful environment.

Evers said Riverbend clinicians try to help out local clients who land in the emergency room, getting them services in the community.

But many of the people coming to Concord Hospital are from outside the area. They often come from the northern part of the state, where mental health resources and beds are scarce.

“In many ways, this is really a systems failure,” New Hampshire Hospital Association President Steve Ahnen said, adding that the lagging community mental health system combined with a lack of inpatientbeds is exacerbating the situation. “We don’t have enough capacity to manage the crisis that exists today.”

Another reason staff are so concerned about the wait times is the emergency room is already chaotic; therefore, it’s one of the worst places for someone experiencing a mental health crisis.

Having to stay in an emergency room for a couple of days is already taxing for a mentally fragile person; staying for weeks can be severely detrimental.

“They want to leave, they try to leave. We’ve had staff assaulted because they want to leave,” Kennedy said.

Concord Hospital staff are quick to praise their security personnel who are regularly on the floor. In addition to guards, they sometimes have a Concord police detail come in to provide extra help.

Staff are trying to cope with this new normal, and hoping more beds are added to the state hospital.

“They are sympathetic, they know where we’re at,” Kennedy said. “They get those numbers every morning.”

All they can do is hope the situation improves.

“We can’t control the front door,” Evers said. “New Hampshire Hospital is controlling it by the fact they’re not discharging people.”

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)