Finding beds for Pennsylvania's mentally ill difficult even when available

Jan. 25--Beds in hospital psychiatric units across the state regularly sit empty even though emergency department physicians struggle to find space for mental health patients requiring inpatient care, according to a Pittsburgh Post-Gazette review of state Health Department data.

Two years ago, the Pennsylvania Medical Society called for the state to create a computerized real-time availability database for beds in hospital psychiatric units. The request -- so far unheeded -- followed doctors' complaints that mental health patients sometimes are held in emergency departments for hours or days while staff members work the phones, trying to find a hospital with an inpatient opening.

Last week, Todd Fijewski, president of the Pennsylvania College of Emergency Physicians, encountered a patient who waited 26 hours for an inpatient bed.

"In all honesty, it's inhumane," said Dr. Fijewski, who works in the emergency departments of various local hospitals.

Hospitals without psychiatric units send all patients requiring inpatient mental health care to other facilities. Hospitals also seek beds elsewhere when their own psychiatric units are full or cannot accommodate patients for other reasons. Some units, for example, take only geriatric patients.

In 2013-14, the most recent period for which data were available, Allegheny County hospitals had psychiatric unit occupancy rates ranging from 59.5 percent to 94.3 percent, according to Health Department figures. The hospitals also had unused capacity in 2012-13, and hospitals in outlying counties regularly have empty beds, too, data show.

Dr. Fijewski said a real-time availability database could help hospitals leverage that capacity more efficiently. He also wants a study of how beds are distributed and whether more should be added.

Heritage Valley Health System, which operates hospitals with adult psychiatric units in Sewickley and Beaver County, agreed that a bed-tracking system would bring efficiency to the search process. In recent years, Heritage Valley said, it has seen an increase in the number of times mental health patients must be held in the emergency department.

State Rep. Dan Miller, D-Mt. Lebanon, has introduced a bill to create the database, but it has gone nowhere so far. He said it's disheartening that doctors cannot easily find inpatient psychiatric beds when he can go "to some website and book a hotel room in five minutes on the other side of the world."

Allegheny Health Network recently established real-time bed tracking for its inpatient units. Emergency departments outside AHN can call to learn about system-wide availability, said Frank Jans, director of psychiatry.

UPMC is developing a system for its inpatient units, including those at Western Psychiatric Institute and Clinic in Oakland. The system will be a resource for UPMC and non-UPMC emergency departments, Camellia Herisko, chief nursing officer and vice president of patient care services at Western Psych, said in an email.

"Bed availability can be challenging. So to ensure we are providing the most effective care to our patients, we are developing new and creative strategies to address this," she said.

The options include "establishing new inpatient units or services that can treat a wider variety of patients, or evaluating a patient's length of stay to determine if we can appropriately discharge the patient to a less acute level of care such as outpatient therapy."

Some professionals cautioned that the surplus capacity isn't as large as the occupancy rates indicate.

Hospitals may need to reserve empty beds for their service areas or forgo new admissions if they have a patient who's acting out, said John Bogdan, nurse manager of Monongahela Valley Hospital's 20-bed adult behavioral health unit, which had a 74.2 percent occupancy rate in 2013-2014.

George Mizikar, director of behavioral health for Excela Health in Westmoreland County, said occupancy rates may not account for beds that were temporarily unavailable because certain patients couldn't have roommates. Also, hospitals may refuse to admit patients with a history of unruly behavior, he said.

In 2013-14, the 11-bed juvenile psychiatric unit at Excela Latrobe Hospital had a 61.3 percent occupancy rate, while the 32-bed adult unit at Excela Westmoreland Hospital had an 82.6 percent occupancy rate.

Also factoring into the placement process are the patient's hospital preferences and insurance coverage and the capabilities of psychiatric units.

"Although a bed tracking system will help identify available psychiatric beds, decisions regarding psychiatric admissions must be based on other important factors, including, but not limited to, the specialized expertise and programming of the unit, and the patient's symptoms, diagnosis and history," Kathe Niznik, St. Clair Hospital's director of psychiatry and mental health services, said in an email. The hospital's 26-bed adult unit had a 78.9 occupancy rate in 2013-14.

Some emergency departments search far and wide for an inpatient bed.

"It's not unusual getting a call from Erie or Ohio or somewhere like that," Mr. Bogdan said.

Mr. Mizikar said Excela, which uses a whiteboard to track inpatient openings at various hospitals, has sent patients as far as Clearfield County.

If one hospital doesn't have a vacancy, "you keep calling until you find one that does," said Bruce MacLeod, medical director of the West Penn Hospital emergency department, who was president of the Pennsylvania Medical Society when the group first called for a bed-tracking system.

Joe Smydo: jsmydo@post-gazette.com or 412-263-1548.

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