The nurse working in the ED of an urban hospital notifies the manager that there are several clients with mental health disorders still present in the ED that have been there over 48 hours. Which issue related to this phenomenon does the nurse discuss with the manager?
A.
Temporary detaining orders for clients.
B.
The revolving door for clients.
C.
Decision to practice boarding.
D.
The cost of holding clients in the ED for over 48 hours.
The Correct Answer and Explanation is:
The correct answer is B. The revolving door for clients.
Explanation:
In an urban Emergency Department (ED), patients with mental health disorders may often face prolonged waits and extended stays due to a variety of systemic issues. When a nurse reports that several clients with mental health disorders have been in the ED for over 48 hours, the issue most relevant to this situation is the revolving door for clients.
The Revolving Door Concept:
The “revolving door” phenomenon refers to a cycle where individuals with mental health disorders frequently enter and leave the healthcare system, particularly emergency departments, without receiving the comprehensive care they need. This cyclical pattern occurs because these individuals may lack access to appropriate follow-up care, stable housing, or community-based mental health services. As a result, they return to the ED repeatedly, often in crisis, rather than receiving ongoing, preventive care that could mitigate their need for emergency interventions.
Why This Phenomenon Occurs:
- Lack of Community Resources: Many urban settings experience a shortage of adequate mental health services, such as outpatient care, supportive housing, and crisis intervention programs. Without these resources, individuals may end up relying on emergency services for their mental health needs.
- Insufficient Discharge Planning: Proper discharge planning is crucial for transitioning patients from the ED to community-based care. Inadequate planning or lack of available resources can lead to individuals returning to the ED when their needs are not fully addressed.
- Barriers to Access: Individuals with mental health disorders may face barriers to accessing appropriate follow-up care, such as transportation issues, financial constraints, or difficulties navigating the healthcare system.
- Crisis Situations: Often, patients with severe mental health issues come to the ED in crisis, and if the crisis is not adequately managed or if there is no suitable follow-up care, they may return to the ED when their condition worsens.
Implications for the ED:
When patients with mental health disorders stay in the ED for extended periods, it not only impacts the quality of care for these patients but also affects the overall efficiency of the emergency department. The “revolving door” issue highlights the need for systemic changes to improve access to mental health services and ensure that individuals receive appropriate and continuous care to prevent frequent emergency department visits. Addressing this issue requires a collaborative approach involving mental health services, social services, and emergency care providers to create a more integrated and supportive system for managing mental health crises.