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Reducing Mental Health Crisis ED Visits and Inpatient Admissions
Key Takeaways
As the demand for mental health crisis support in the emergency department (ED) has increased, Cincinnati Children’s has found a way to keep ED visits down and reduce inpatient admissions.
The approach to crisis-based management at Cincinnati Children’s focuses on getting patients in crisis the precise care they need, prioritizing the Psychiatric Intake Response Center (PIRC) phone line, PIRC Bridge Crisis Clinic and community outreach.
Advocacy, both within Cincinnati Children’s and out in the community, helps improve crisis response, so providers and patients know their options beyond an emergency room visit.
As hospitals across the country see more patients use the emergency department (ED) for mental health needs, Cincinnati Children’s has found an approach that not only keeps ED visits down but also reduces resulting inpatient admissions.
We’re trying to provide care that is appropriate and timely. We connect patients with the right level of care for their needs, which is not always an inpatient admission.
Sam Vaughn, MD, PhD
Through the Psychiatric Intake Response Center (PIRC), PIRC Bridge Crisis Clinic and other outreach initiatives, Cincinnati Children’s is responding more effectively to pediatric mental health needs—even becoming a blueprint for other health systems.
“We’re trying to provide care that is appropriate and timely,” says Sam Vaughn, MD, PhD, the medical director for PIRC. “We connect patients with the right level of care for their needs, which is not always an inpatient admission.”
Coordinated Crisis Services Focus on Crisis Management
Clinicians at Cincinnati Children’s do a lot of psychiatric evaluations in the ED—an average of 7,100 in the last seven years. As demand for mental health crisis support in the emergency room has continued, they’ve noticed some patterns.
“We realized there was a need for crisis services, which is what led to the Bridge Clinic,” says Jennifer Spitznagel, LISW-S, clinical director of PIRC. “By offering Bridge appointments instead of patients coming to the emergency room, we can manage crisis on an outpatient basis. And we can encourage the community to call us before they send kids to the ER.”
Cincinnati Children’s has mental health staff, who specialize in crisis-based services, do rotations in the ED and support these crisis initiatives:
The total average time spent in the ED for patients with a mental health concern was just below 21 hours in 2022 and 2023. For 2024, it’s less than nine hours.
Cincinnati Children’s clinicians have completed, on average, 7,100 psychiatric evaluations in the ED in the last seven years.
Access behavioral and mental health services at Cincinnati Children’s by calling PIRC
at 513-636-4124.
PIRC: A dedicated group of clinicians who answer crisis calls for people from the community. They help direct patients and providers to care based on their needs, often diverting them from the ED.
PIRC Bridge Crisis Clinic: An outpatient clinic that offers crisis stabilization, outside of the ED, with a social worker or clinical counselor. Recently, the clinic has expanded to see patients in crisis who might need medication management.
Outreach groups: Teams who educate people in schools, community groups and other departments about crisis management.
“I don’t think that we’re doing any one thing that differently than anybody else,” says Vaughn. “But what makes our approach unique is the combination of pieces we have all in the same place and how we coordinate those pieces.”
Better Mental Health Care Improves Health Outcomes
Since the expansion and better coordination of diversion work and crisis appointments, the PIRC team is starting to notice a shift. The monthly inpatient admission rate for the Psychiatry unit, at 44.6% in 2023, is at 37.5% in 2024. Additionally, for patients who go to the ED for a mental health concern and are admitted to the hospital, the total average time spent in the ED was just under 21 hours in 2022 and 2023. In 2024, it’s currently less than nine hours.
PIRC has plans to measure the long-term impacts of their crisis management approach, with data to support that more patients are receiving the specific type of care they actually need.
“One of the benefits we hope for is we’re connecting people with the right level of care, so they can be more stable in the community as opposed to in and out of the hospital,” says Vaughn. “As we help stabilize patients in the community and not in the hospital, we reduce the risk for both staff and patients of having adverse outcomes while hospitalized.”
The Role of Outreach and Education for Crisis Response
A big part of reducing mental health crisis ED visits and admissions is advocacy and collaboration both within and outside of Cincinnati Children’s.
We want to empower schools, primary care doctors and anyone else who’s interacting with kids in crisis to call us first and explore options outside of emergency rooms. We certainly want to help the kid who’s in crisis, but we want to do it in the right setting.
Jennifer Spitznagel, LISW-S
“We want to empower schools, primary care doctors and anyone else who’s interacting with kids in crisis to call us first and explore options outside of emergency rooms,” says Spitznagel. “We certainly want to help the kid who’s in crisis, but we want to do it in the right setting.”
“We have really good ways of communicating between us,” says Spitznagel. “So, when a kid is in crisis, we’re able to get them the level of care they need, whether it’s the ER or Bridge or even just reaching out to a parent who’s not sure what to do. That open communication and making sure everybody understands what we can offer in a crisis has been important.”
