Screening Out Does Little to Address ED Overcrowding

I found the September 2009 article “Guesting Area: An Alternative for Boarding Mental Health Patients Seen in the Emergency Department”1 to be extremely interesting. I currently work in a rural emergency department in central North Carolina that has 36 regular ED beds, 4 trauma rooms, and a 10-bed holding area for patients waiting on a bed assignment when admitted. We constantly are confronted with cases of psychiatric patients coming to the emergency department, being admitted, and then having no place to go. Often our behavioral unit upstairs is full or the patients who are being admitted do not meet the criteria for admission at our facility, which means the task of finding an accepting facility then begins. We have had patients wait in our emergency department for more than 18 hours at a time because they simply don't have an accepting facility to go to.

Utilizing a guesting area for these patients who have to wait so long is a great idea. A communal area can be created where a nurse can watch a few different psychiatric patients at the same time, which would free up more ED beds. The fact that a guesting area is a quieter and calmer environment than the emergency department also would be beneficial to this population. Any method that can be used to decrease unnecessary stimulation is good for psychiatric patients.

The fact that utilizing such an area at St. Joseph Hospital has lead to no elopements from the emergency department since 2003 proves that the guesting area has positive benefits. Thank you for sharing this idea. I plan to discuss the possibility of creating such an area at our own emergency department at our next staff meeting.