Latest / Becker's Healthcare Behavioral Health / Connecting the Front Door: How Real-Time Technology and AI-Enabled Intake Improve ED Throughput, Operational Efficiency, and Patient Care

Transcript

Connecting the Front Door: How Real-Time Technology and AI-Enabled Intake Improve ED Throughput, Operational Efficiency, and Patient Care · Becker's Healthcare Behavioral Health

• 0:00
  Hi, everyone. This is Erica Spicer Mason with
• 0:02
  Becker's Healthcare. Thank you so much for tuning
• 0:04
  in to the Becker's Healthcare podcast series.
• 0:07
  Today, we're going to talk about reducing ED
• 0:10
  boarding and how real time intake and AI
• 0:13
  are changing behavioral health access.
• 0:15
  Joining me for this conversation, we have with
• 0:17
  us Shanna Palmeri,
• 0:19
  chief clinical officer and cofounder of Transveral.
• 0:23
  Shanna, thank you so much for being here
• 0:25
  today. Welcome.
• 0:26
  Thank you so much for having me. It's
• 0:27
  a pleasure. Yeah. We're we're thrilled to have
• 0:29
  you with us. And to kick us off,
• 0:31
  can you share just a little bit more
• 0:33
  about yourself and your work in health care?
• 0:36
  Absolutely. My background, I'm a licensed clinical social
• 0:38
  worker.
• 0:39
  So I started out, in my career in
• 0:42
  direct practice.
• 0:43
  I worked actually in London for a little
• 0:45
  bit for the National Health Service, and
• 0:48
  then I spent some time
• 0:49
  working in emergency psychiatry.
• 0:52
  So direct practice on geriatric psychiatry units, did
• 0:55
  some outpatient behavioral health work, worked in the
• 0:57
  foster care system, and then I eventually,
• 1:00
  worked at an academic medical center in the
• 1:02
  District Of Columbia and helped them design and
• 1:05
  build a behavioral health division.
• 1:07
  So I did a lot of work with
• 1:09
  our emergency department and our emergency psychiatric services.
• 1:13
  And at that time, I also ran
• 1:15
  and had oversight for our inpatient psychiatric unit.
• 1:18
  So had a lot of experience on
• 1:20
  the issues around emergency department boarding,
• 1:24
  some of the issues around staffing models,
• 1:29
  and,
• 1:30
  making sure we were using our clinically
• 1:32
  trained staff effectively,
• 1:35
  looked a lot at the capacity issues in
• 1:37
  the emergency department, risk events. So this sort
• 1:39
  of holistic picture of how do patients move
• 1:42
  through the system became really integral into my
• 1:44
  role there. And that's really where I became
• 1:47
  very invested in this problem was watching the
• 1:50
  day to day impact both on
• 1:52
  the business and operation side in health care
• 1:55
  and also the clinical quality of care issues
• 1:57
  that came up as a result of emergency
• 1:59
  department boarding for this specific patient population.
• 2:03
  So after that, I transitioned into technology.
• 2:06
  Yeah. Shanna, it it's great to hear that
• 2:09
  your background was
• 2:10
  I I mean, you've seen these issues front
• 2:12
  and center in your work on the ground
• 2:15
  and and internationally
• 2:16
  as well. So you really do have you're
• 2:18
  bringing this holistic perspective to such a pervasive
• 2:21
  issues. We know that EDs across the country
• 2:24
  are really struggling with behavioral health boarding.
• 2:27
  So I'd like
• 2:28
  to learn a little bit more of your
• 2:30
  perspective on that. You know, what have you
• 2:32
  seen drive prolonged
• 2:34
  ED stays for psych patients, and where do
• 2:36
  you think breakdowns happen the most often?
• 2:39
  Yeah. It's such an interesting topic, I think,
• 2:41
  because when
• 2:43
  you read a lot of news articles and
• 2:45
  what's out there, right, we always hear this
• 2:47
  conversation
• 2:48
  around
• 2:49
  having not enough behavioral health resources, not enough
• 2:52
  behavioral health beds that are available.
• 2:54
  And that is absolutely true some of the
• 2:56
  time.
• 2:57
  But what I really found was that there
• 3:00
  were a couple fundamental problems that we were
• 3:02
  seeing in the emergency department setting, and one
• 3:04
  was really operational.
• 3:06
  Right? So we are using an extremely manual
• 3:09
  based system
• 3:10
  to transfer patients throughout the behavioral health system
• 3:13
  nationwide.
• 3:15
  So every single clinician in every single hospital
• 3:17
  has to have an awareness of where are
• 3:20
  all of the hospitals,
• 3:21
  What clinical capabilities do they have? What age
• 3:24
  range patients do they take? Where are they
• 3:25
  located?
• 3:26
  What's the fax number for them all? What
• 3:28
  information are they requesting?
• 3:30
  And then they're picking up the phone and
• 3:32
  they're making phone calls, right, trying to find
• 3:34
  and sort through this sort of maze of
• 3:37
  resources.
• 3:38
  And
• 3:39
  even if I, you know, I hired a
• 3:41
  number of staff, we would try the hospitals
• 3:43
  that we always knew, and if they were
• 3:45
  full, then the patients would just wait. Right?
• 3:47
  And meanwhile, maybe forty five minutes further, if
• 3:49
  we had tried and we had known that
• 3:50
  a hospital was there, we would have tried
• 3:52
  that hospital and the patient could have been
• 3:53
  accepted. Right? Or where is the specific
• 3:56
  clinical program that best matches a patient?
• 3:59
  And so there's this challenge that we have
• 4:02
  of this system that it's not all connected
• 4:04
  together.
• 4:05
  And so what a lot of hospitals and
• 4:07
  health systems do, right, is they develop a
• 4:10
  a system for their health system,
• 4:12
  but the patient the interhospital
• 4:14
  patient transfer system means that we have to
• 4:15
  look at the system across an entire network
• 4:18
  and across networks of hospitals. And so there
• 4:20
  was this fundamental problem there with how do
• 4:23
  we link up, how do we keep awareness
• 4:25
  of all these resources. And then we're also
• 4:27
  using really, you know, sort of these old
• 4:29
  school
• 4:30
  processes,
• 4:31
  sending a fax, making phone calls, waiting for
• 4:34
  a return phone call,
• 4:35
  to get back and forth. And then you
• 4:37
  look at the intake side of it. Right?
• 4:39
  So there's these intake departments of the behavioral
• 4:42
  health units, and they're seeing walk in patients.
• 4:44
  They're getting phone calls, faxes, emails. They're in
• 4:47
  all these different platforms. I've gone and sat
• 4:49
  in some of these intake departments and managed
• 4:51
  my own intake department, and there's just lines
• 4:53
  of paper stacked up with sticky notes on
• 4:55
  it, and then there are shift change happening.
• 4:58
  And so you have this process that at
• 5:00
  its base level is very manual and just
• 5:03
  right from missing things or
• 5:05
  errors to happen or really long delays.
• 5:09
  And then when we look at true capacity
• 5:11
  issues in behavioral health, there's not really great
• 5:14
  datasets available for, well, which patients do wait
• 5:18
  the longest, what types of patients are not
• 5:20
  getting accepted,
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  and what regionally
• 5:24
  do,
• 5:24
  services are missing for certain types of patients.
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  And so because the process is manual,
• 5:30
  we're not able to collect data to drive
• 5:32
  continuous quality improvement or understand
• 5:35
  regionally or statewide
• 5:37
  where our needs in geographic areas for certain
• 5:41
  types of behavioral health patients that may be
• 5:43
  the ones who are boarding the longest in
• 5:45
  these emergency departments.
• 5:46
  So there's all of these sort of administrative
• 5:49
  and system level,
• 5:51
  logistics
• 5:52
  that really underlie this ED boarding problem, for
• 5:55
  behavioral health patients specifically.
• 5:59
  You've painted such a vivid picture, Shanna, and
• 6:02
  just that phrase that you used earlier in
• 6:04
  your response, the maze of resources
• 6:06
  that Yeah. Have to get through. I
• 6:09
  mean, I feel overwhelmed hearing about it, so
• 6:11
  I cannot imagine what it feels like
• 6:13
  to be on the ground,
• 6:15
  you know, handling this administrative
• 6:17
  load. So that that kind of brings me
• 6:20
  to what I wanted to touch on next.
• 6:21
  I know you said you've brought a lot
• 6:23
  of your,
• 6:25
  your clinical and frontline facing work to the
• 6:28
  technology space. So I'd love to know how
• 6:31
  in light of all those challenges we just
• 6:33
  touched on, how does connecting emergency departments,
• 6:36
  case management teams, and these intake teams that
• 6:39
  you've touched on as well, how does connecting
• 6:41
  them in real time actually change patient flow,
• 6:44
  referral accuracy, and decision making at the same
• 6:47
  time?
• 6:48
  Absolutely. So you can imagine this picture. Right?
• 6:51
  And it could be a a small critical
• 6:53
  access hospital with a nurse and or it
• 6:55
  could be a large health system with
• 6:58
  a very experienced,
• 6:59
  command center,
• 7:01
  specialist.
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  But these individuals
• 7:03
  sometimes have long lists, right, with all the
• 7:05
  behavioral health hospitals on it and what types
• 7:07
  of patients they take. And then when they
• 7:09
  find that something new has changed, they cross
• 7:11
  it out, and they put a new note
• 7:13
  for the next, you know, person who comes
• 7:14
  in. Oh, they take adolescents now, or they
• 7:16
  no longer take this type of patient. And
• 7:18
  you're constantly updating this. When you move into
• 7:21
  a system that's network based, that's a technology
• 7:24
  that's constantly updating in real time with accurate
• 7:27
  information,
• 7:29
  and has both sides. Right? So you have
• 7:31
  the hospitals
• 7:32
  on the platform that are trying to find
• 7:35
  beds, and then you have receiving hospitals along
• 7:37
  the continuum of care for behavioral health that
• 7:40
  can update their profile in real time. Right?
• 7:43
  And not only that, they're able to communicate
• 7:45
  in real time through a HIPAA compliant platform.
• 7:48
  So now instead of making
• 7:50
  12 phone calls for one patient and sending
• 7:53
  a fax and waiting for phone calls back,
• 7:55
  you're in a platform that's team based with
• 7:58
  all of your coworkers
• 7:59
  that can see this as well,
• 8:01
  and you can
• 8:03
  upload your patient's information.
• 8:04
  The system is gonna clinically match to all
• 8:07
  of the patient's
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  clinical needs, age,
• 8:10
  the different capabilities that that patient needs to
• 8:12
  the receiving hospitals. And then you click which
• 8:15
  ones you wanna send it to, and it
• 8:16
  beacons out and alerts them in real time.
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  And they get an instantaneous
• 8:20
  message. Them and all their colleagues can see
• 8:22
  this and respond back and forth, and everything's
• 8:25
  tracked as well. So when shift change happens
• 8:28
  in the hospital,
• 8:29
  now instead of a little note somebody leaves
• 8:32
  you, right, on your sign out, you have
• 8:34
  a detailed log of everything that happened for
• 8:36
  every single behavioral health patient, whether you're accepting
• 8:39
  that patient at your receiving hospital or you're
• 8:41
  trying to find a bed. And so it
• 8:43
  creates
• 8:44
  this,
• 8:46
  efficiency
• 8:47
  both to find,
• 8:48
  the care that matches the patient's clinical needs
• 8:51
  the best. It also creates a significant amount
• 8:53
  of efficiency for the staff. So the patients
• 8:56
  end up spending a lot less time in
• 8:58
  the emergency department. It takes a lot less
• 9:00
  clinical hours from those health care providers to
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  do the work.
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  And one of the things that's been really
• 9:06
  important to me over the years as well
• 9:08
  is that patients are going to hospitals
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  that have the best match of a unit
• 9:13
  for them. And I think for a long
• 9:14
  time,
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  psychiatry was kind of looked at as, well,
• 9:18
  if the patient has a psychiatric need, they
• 9:20
  can all go to any psychiatric hospital.
• 9:22
  Right? But you really are gonna be much
• 9:25
  better off and get better outcomes if your
• 9:27
  patient with,
• 9:29
  you know, Alzheimer's or dementia that needs to
• 9:31
  be admitted to a psychiatric unit goes to
• 9:33
  a geriatric psychiatry unit with,
• 9:36
  psychiatrists specialized in those,
• 9:39
  diagnoses.
• 9:40
  And if you have, you know, a patient
• 9:43
  who's pregnant, there's very few units within The
• 9:46
  United States that have specific programs for pregnant
• 9:49
  women,
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  but there are some and most patients would
• 9:53
  probably prefer to go to that unit,
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  or for somebody with PTSD to go to
• 9:57
  the unit that treats PTSD. And so it's
• 10:00
  impossible for, clinicians in the emergency department to
• 10:03
  memorize all of this or understand where these
• 10:05
  units are at, but a technology is able
• 10:07
  to really route patients and lift that information
• 10:10
  to these clinicians so that patients can get
• 10:13
  better outcomes at the end of the day
• 10:14
  in addition to not sitting in the emergency
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  room for so long.
• 10:19
  And that efficiency,
• 10:20
  I'm sure, is so important
• 10:22
  when we're talking about behavioral health conditions, whether
• 10:25
  that be someone is in crisis mode or,
• 10:28
  just when I think about patient satisfaction in
• 10:31
  general and patient experience,
• 10:33
  you know, behavioral health
• 10:35
  crisis or,
• 10:36
  situation or challenge,
• 10:38
  being able to be linked to the right
• 10:40
  provider
• 10:41
  sooner,
• 10:42
  I'm sure goes such a long way. I
• 10:44
  mean, for any health care patient, but for
• 10:46
  some reason in this conversation, for behavioral health,
• 10:48
  that is just ringing especially true from an
• 10:50
  efficiency standpoint.
• 10:53
  Absolutely. There's so many risk events that happen
• 10:55
  in the emergency department
• 10:57
  because patients wait for too long. And we
• 11:00
  look at quality of care as health care
• 11:02
  providers, finding
• 11:04
  tools that help us reduce ED length of
• 11:06
  stay and models
• 11:08
  that help us provide more compassionate care to
• 11:10
  this patient population is so critical. They're coming
• 11:13
  to us in their most challenging distressing moments,
• 11:16
  and our job as providers, whether we're doing
• 11:19
  direct care or we're doing system design,
• 11:22
  is to find a way to help our
• 11:24
  patients deescalate from a crisis. And what we
• 11:26
  see when patients board is that many times
• 11:28
  that crisis gets escalated,
• 11:31
  whether they have to get emergency medications or
• 11:33
  sometimes patients end up in restraints. These are
• 11:35
  really traumatizing
• 11:37
  incidents for patients in the emergency department, and
• 11:40
  then health care workers can get hurt as
• 11:41
  well. So when we reduce that time that
• 11:44
  they're in the emergency department and get them
• 11:46
  to a setting that is
• 11:48
  meant for managing a behavioral health crisis, we
• 11:51
  see these,
• 11:52
  incidents go way down.
• 11:54
  So it just all around is such a
• 11:56
  great thing when you can see systems and
• 11:58
  health care systems adopt
• 12:00
  technology and system level solutions,
• 12:03
  and models that help provide really trauma informed
• 12:06
  care through reducing the amount of time that
• 12:08
  patients spend in an emergency department.
• 12:11
  Yeah. Absolutely.
• 12:12
  And, Shanna,
• 12:14
  along those lines, I wanted to also
• 12:16
  talk a little bit about AI. What would
• 12:18
  a technology conversation nowadays be if we didn't
• 12:21
  touch on AI? Mhmm. And I know you
• 12:23
  had mentioned so many challenges from a administrative
• 12:26
  standpoint with the patient intake process.
• 12:29
  So where are you seeing AI add value
• 12:32
  in intake operations right now, and how is
• 12:34
  it helping teams manage those referral volumes and
• 12:37
  also
• 12:38
  preserve accuracy and clinical judgment as well as
• 12:41
  safety?
• 12:42
  Absolutely. I am a
• 12:45
  significant fan of AI in certain use cases.
• 12:48
  I think that clinicians
• 12:50
  are still
• 12:51
  meant to be making final clinical decisions and
• 12:54
  judgment. And where I think that, AI is
• 12:57
  really, really helpful and impactful for
• 13:00
  patient care is improving access
• 13:03
  through,
• 13:04
  accuracy
• 13:05
  and also the speed we can get to
• 13:06
  a decision and also making sure that we
• 13:08
  don't miss critical elements of a patient's care.
• 13:11
  So when we look at intake, we think
• 13:13
  about there's just volumes and volumes of referrals
• 13:16
  coming into these intake departments, and they're trying
• 13:18
  to determine if patients if their hospital has
• 13:21
  the clinical ability to care for the patient.
• 13:23
  And then if they do, they wanna make
• 13:25
  sure that they're ready when that patient arrives
• 13:27
  to care for them. And some of these
• 13:29
  clinical packets that come over to be assessed
• 13:32
  can be anywhere from 40, a 100, sometimes
• 13:36
  up to 250
• 13:37
  pages long of records.
• 13:40
  And
• 13:41
  for somebody to read through all of that
• 13:43
  detail would take a significant amount of time.
• 13:45
  So what we find oftentimes, right, is these
• 13:48
  clinicians are scanning through just reams of paper
• 13:51
  trying to find the information that they need.
• 13:54
  And where I see significant benefit from AI
• 13:57
  is that we can start to lift the
• 13:59
  information they're looking for really quickly and find
• 14:02
  that
• 14:02
  so that we have improved accuracy. We understand
• 14:06
  what what the abnormal labs are, what the
• 14:08
  critical issues that the patient may be facing,
• 14:10
  what needs to be done to prepare for
• 14:12
  that patient's arrival, making sure that they're an
• 14:14
  appropriate fit for the hospital.
• 14:16
  And it really helps these clinicians not miss
• 14:18
  anything that's critical,
• 14:21
  to make sure that the patient's appropriate and
• 14:23
  they can be transferred. And it saves a
• 14:24
  lot of time as well so that that
• 14:26
  patient can transfer more quickly and get into
• 14:29
  the care that they need to.
• 14:31
  Absolutely.
• 14:33
  And, Shanna, I know we've touched on already
• 14:35
  some of the measurable improvements that you're seeing
• 14:37
  across organizations that are taking this tech driven
• 14:40
  approach. We've touched on Mhmm. How it can
• 14:43
  impact efficiency,
• 14:45
  administrative burden, patient satisfaction and experience, and ultimately
• 14:49
  staff safety as well.
• 14:51
  But as we close, just wanted to give
• 14:52
  you the opportunity to highlight any other,
• 14:56
  you know, metrics or or outcomes that you're
• 14:58
  seeing organizations
• 15:00
  realize as a result of innovating
• 15:02
  here and maybe even a practical first step
• 15:04
  leaders could take to move in that direction
• 15:06
  as well?
• 15:07
  Absolutely. So I think one of the things
• 15:09
  that we look at I'll I'll start with
• 15:11
  hospital systems that are trying to move patients
• 15:13
  out of their emergency department.
• 15:15
  We've gone back and worked with these systems
• 15:17
  to pull out how how much improvement have
• 15:19
  you got in ED door to door time,
• 15:21
  how many hours less are patients spending in
• 15:23
  your ED as a result of implementing
• 15:25
  this type of technology that Transfrotto provides. One
• 15:28
  of our large health systems in California,
• 15:30
  their results showed, on average, six point five
• 15:34
  hours taken off each patient stay throughout their
• 15:37
  organization.
• 15:38
  We've had children's hospitals report up to a
• 15:40
  seventy seven zero percent decrease in ED door
• 15:44
  to door time for children leaving their ED
• 15:46
  as a result of transitioning. So we see
• 15:49
  significant time savings
• 15:51
  of patients not spending those hours in the
• 15:53
  emergency department.
• 15:54
  When we look at intake departments,
• 15:56
  we see,
• 15:58
  intake departments able to respond more quickly,
• 16:02
  accept patients more quickly,
• 16:04
  spend up to 90% less time, administrative time,
• 16:08
  trying to find information in packets,
• 16:11
  with the use of,
• 16:12
  our AI tool. So on both sides, so
• 16:15
  impactful in terms of the ability to improve
• 16:19
  access to care for these patients and help
• 16:21
  them move quickly to the hospital they need
• 16:23
  to be in.
• 16:24
  And I think for,
• 16:26
  you know, recommendations for health systems, I think
• 16:28
  the technology
• 16:29
  is here, and it's being used in a
• 16:31
  lot of different areas, I think, for
• 16:34
  specifically this area around behavioral health boarding. Having
• 16:37
  been a clinician working in the emergency department
• 16:40
  and running a team using very manual based
• 16:42
  processes
• 16:43
  and then being able to work with health
• 16:44
  systems who are
• 16:46
  doing a number of different,
• 16:48
  restructure and redesigns everywhere from command centers to
• 16:51
  implementing technology
• 16:53
  using
• 16:54
  AI. These are where I see a lot
• 16:56
  of innovation happening as we move into the
• 16:58
  future to really solve and create sustainable practices
• 17:02
  to move away from patients boarding in the
• 17:05
  emergency department and getting into the care that
• 17:07
  they need.
• 17:08
  Shanna, this is such an important conversation we've
• 17:10
  had, and I just wanna thank you for
• 17:12
  the time and the insights that you've offered
• 17:14
  to our listeners and some practical first steps
• 17:17
  and considerations
• 17:18
  that leaders can take to move in this
• 17:19
  direction of,
• 17:21
  ensuring patients are flowing through the ED and
• 17:23
  being,
• 17:25
  directed to the sites of care that are
• 17:27
  best suited for them.
• 17:28
  It's been great learning from you today.
• 17:30
  Thank you so much. It was really a
• 17:32
  pleasure to be here to talk on this
• 17:33
  conversation.
• 17:35
  And we also wanna thank our podcast sponsor
• 17:37
  for today, Transfural.
• 17:39
  Listeners, be sure to tune in to more
• 17:40
  podcasts from Becker's by visiting our podcast page
• 17:44
  at beckershospitalreview.com.