As an emergency physician, Alister Martin, MD, MPP, MGH Emergency Medicine, learned countless lessons working through the COVID-19 pandemic.
This week, the Massachusetts General Hospital Acute Psychiatry Service (APS) opened a newly renovated and expanded unit for both pediatric and adult patients experiencing psychiatric, neuropsychiatric and substance-use emergencies. The new space features 20 dedicated patient rooms in one area—an upgrade from the prior space of six patient rooms dispersed throughout the Emergency Department (ED)—as well as larger spaces for children and their families, and a sitting area for patients.
“Psychiatric patients often have lengthy stays in the ED, which can feel uncomfortable, over-stimulating and lacking in privacy,” says Suzanne Bird, MD, Mass General APS director. “This new service will allow us to provide a quieter, less crowded and more comfortable environment in which patients can reliably sleep, speak privately to providers and receive primary management from a multidisciplinary psychiatric team. It will also allow a safer and more attractive environment for our pediatric patients and their families for whom the chaotic environment of the general ED can be particularly stressful.”
The Mass General APS is one of the busiest psychiatric emergency services in the northeast, providing emergency psychiatric care for more than 7,000 patients per year.
“Our service, along with Emergency Medicine, brought the challenge of a significant increase in patient volume and problematic conditions to the attention of departmental and hospital leadership,” says Curtis Wittmann, MD, APS associate director, along with Abigail Donovan, MD. “The plans were started about three years ago with identification of a suitable space, followed by an extremely collaborative process in which we developed this unit to better serve our patients.”
The unit was initially slated to open in the fall of 2021, but plans were expedited as the service’s patient volume continued to rise. Emergency Department nursing played a crucial role in ensuring the APS area was ready by the shortened timeline by overseeing the hiring process of nurses, mental health experts and patient care associates, while also assuring regulatory compliance.
“There was tremendous support from managers and directors throughout Patient Care Services,” says Christina Stone, RN, associate chief nurse of Case Management, Community, Capacity Coordination and Emergency Services. “We are thrilled to have this wonderful, warm clinical space to care for this vulnerable patient population. We have dedicated mental health specialists who interact with the patients to not only help us put them on the path to better health, but also make sure they spend less time in the Emergency Department. This therapeutic space will greatly help us to provide the best care to our patients.”
Stone says support of the project is far-reaching across the institution and within several role groups, including Nursing, and credits Melissa Pineo, RN, nurse director in the Emergency Department, and Margaret Ford, RN, nurse manager in the Emergency Department, for their assistance in getting the unit up and running. Mass General Police and Security’s Bonnie Michelman, executive director, John Driscoll, associate director, and Ryan Curran, operations manager, also played essential roles in the creation and support of the APS, Stone says.
Wittman says the new unit also advances clinicians’ ability to safely and humanely care for patients who experience a psychiatric crisis and turn to Mass General for care. “The environment of care is important when caring for any patient, but helping our patients experience a calm, protected and quieter environment will help them to sleep and engage with care. We have hopes that by providing more dedicated space to our patients we will be able to initiate treatment earlier and hopefully decrease the length of stay for patients in our Emergency Department,” says Wittmann.
David Brown, MD, chief of Emergency Medicine, credited Peter L. Slavin, MD, Mass General president, and Timothy G. Ferris, MD, MGPO CEO, for their support of the expansion project. “We are very excited to open this new and enlarged unit to care for patients with acute behavioral health emergencies. The previous APS was markedly undersized for our current volume, creating challenges in their care delivery, as well as challenges for the staff caring for other ED patients.”
“This dedicated unit will provide state-of-the-art emergency psychiatric care to some of our most marginalized, stigmatized patients, and by co-locating the psychiatric clinicians and nurses with our patients in a safe and non-stimulating milieu, we will optimize the care and treatment of this population,” says Robert Seger, executive director for Emergency Medicine.
“Mass General has always been a leader among hospitals in this state—and in the country—in providing robust psychiatric services,” says Joy Rosen, vice president, Mass General Psychiatry. “The expansion and renovation of this space and accompanying expansion of staffing, sends a strong message to our patient and staff community about our principles and values as a hospital, providing patients who are acutely ill with psychiatric disorders a dignified and calming environment where they will receive the care they need.”
“Psychiatric emergencies have been rising over time and the COVID-19 pandemic has clearly greatly exacerbated this trend,” says Maurizio Fava, MD, chief of Mass General Psychiatry. “Patients who come to Mass General for emergency psychiatric care will finally have a welcoming place for evaluation and treatment, a place when they can feel safe and comfortable, with a large team of mental health providers closely engaged in their care.”
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