124 - From Emergency Response to Community Outreach: A Systems Based Approach to Psychiatric Crisis Care

Publication Number: 1114.124

Sam Vaughn, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer M. Spitznagel, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Monica T.. vonAhlefeld, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer Wallsteadt, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States; Martine Lamy, Cincinnati Children's Hospital Medical Center, CINCINNATI, OH, United States

Background: The youth mental health crisis, marked by rising rates of depression, anxiety, suicidal ideation and youth death by suicide is a global health concern. Emergency Departments (EDs) often serve as the first point of care, resulting in prolonged boarding while awaiting psychiatric services.

Objective: We describe a systems-based approach to timely crisis care that reduces reliance on ED and inpatient psychiatry by shifting mental health care to outpatient and community-based care.

Design/Methods: Using the Model for Improvement, the team developed process maps, identified failure modes and created SMART and Global aims within key driver diagrams. These drivers then informed intervention implemented via Plan-Study-Do-Act cycles. Key efforts included increasing crisis calls through community outreach and forming a Crisis Assessment Team: licensed clinicians providing phone-based triage to connect individuals in crisis with timely, appropriate care. Additionally, bridge to ongoing care visits (bridge) and ED diversion capacity were expanded through staff recruitment and training. Psychiatrist involvement in ED evaluations was increased, along with availability of a dedicated psychiatrist or APRN. Outcomes were tracked via ED evaluations, admission rates, ED length of stay (LOS), bridge and ED diversion visits, number of crisis calls and resulting recommendations.

Results: Over the past 3 fiscal years (July-June), the number of yearly ED evaluations have declined slightly from 7,020 to 6,543 (7%) while the admission rate has decreased by nearly 10%, from 45% to 36%. Notably, despite the small decline in total evaluations, ED boarders and overflow patients have dropped by 60%, from 2,076 in 2023 to 830 in 2025, with average ED LOS declining 38% (from 833 minutes to 516 minutes). Crisis calls have increased 63% (from 2,005 to 3,272) with community outreach events increasing 15% (from 65 to 75). Finally, bridge visits have nearly doubled, increasing 98% (1,237 to 2,253). Crisis call recommendations proved reliable, as fewer than 10% of patients advised to avoid the ED were admitted within 7 days (291 in FY25).

Conclusion(s): This approach has significantly reduced both the number of patients waiting for admission and LOS. Increased crisis calls and bridge visits reflect successful outreach and diversion efforts. Continued community engagement and crisis services are expected to further reduce ED visits and support earlier intervention, improving youth mental health outcomes.