MMA Board Approves Recommendations on Emergency Department Boarding of Patients with Psychiatric Diagnoses

June 1, 2023

On May 20, the MMA Board of Trustees approved a list of recommendations designed to reduce the incidence, and improve the quality, of emergency department boarding of patients with psychiatric diagnoses (EDBPPD) in Minnesota. 

The recommendations are part of a 44-page report produced by a task force convened by the MMA and the Minnesota Chapter of the American College of Emergency Physicians (MNACEP).  

The task force met for nine, two-hour meetings over four years to research, discuss, and develop recommendations on EDBPPD, taking a one-year break during the height of the COVID-19 pandemic. 

MNACEP first approached the MMA in May of 2019 to sign a letter asking Gov. Tim Walz to address EDBPPD. In lieu of the letter, the MMA and MNACEP created the task force. 

"This is a critical issue. Many Minnesotans have to spend days, and sometimes weeks, in emergency departments waiting for available hospital or residential treatment beds," says task force co-chair Dionne Hart, MD.  “Taking action is long past due.” 

"The recommendations that our task force developed offer up a game plan on addressing this complex issue," says task force co-chair Drew Zinkel, MD. "It's a big lift but desperately needed." 

The task force’s recommendations include:  

1. Recommendations spanning the ED boarding continuum. 

• Publicize and circulate the report to inform and empower leaders* 

• Support the creation of a Minnesota ED boarding database* 

• Collaborate to improve the usefulness of mental healthcare search tools in Minnesota* 

• Strategize to improve the size, distribution, and diversity of the mental healthcare workforce in Minnesota 

• Protect and expand the use of telehealth for mental health services* 

2. Recommendations for inflow factors (that lead to high ED utilization by patients in mental health crises). 

• Support the financial sustainability of 988 Call Centers in Minnesota 

• Explore emergency transport diversion to EDs in hospitals with patient-appropriate inpatient mental health beds 

• Leverage healthcare workers and facilities to educate the public about mental health resources* 

• Support legislation to require Minnesota health plans to reimburse for collaborative care model services* 

3. Recommendations for stalling factors (that potentially worsen the mental and physical health of boarding patients). 

• Support the development and evaluation of alternative emergency facilities for patients with psychiatric diagnoses who await disposition 

• Advocate for an increase in ED-designated mental healthcare workers* 

4. Recommendations for outflow factors (why mental health patients get stuck boarding in EDs). 

• Advocate for more inpatient mental health hospital beds in Minnesota 

• Advocate for more residential treatment beds in Minnesota 

• Monitor and engage in the development of locked Intensive Residential Treatment Services (IRTS) facilities in Minnesota 

• Support legislation to require Minnesota health plans to cover Psychiatric Residential Treatment Facilities (PRTF) and IRTS* 

• Collaborate to reduce the burdens of corporate foster care on ED boarding. 

Note: Recommendations marked with an asterisk (*) are those the task force identifies as actions that the MMA and MNACEP, as medical associations, are uniquely positioned to leverage best. 

The task force consisted of 17 emergency medicine physicians and mental health advocates including: 

• Co-Chair Dionne Hart, MD, director, Care from the Hart; psychiatry, Hennepin Healthcare; MMA Board of Trustees Member  

• Co-Chair Drew Zinkel, MD, senior medical director of emergency medicine, University of Minnesota; past president, Minnesota Chapter of the American College of Emergency Physicians 

• Sue Abderholden, MPH, executive director, NAMI Minnesota (National Alliance on Mental Illness) 

• Kathleen Heaney, MD, psychiatry, Hennepin Healthcare 

• Sara Hevesi, MD, senior associate consultant (Emergency Medicine), Mayo Clinic 

• Larry Hook, MD, psychiatry, CentraCare Hospital St. Cloud 

• Matt Kruse, MD, psychiatry, Anoka Metro Regional Treatment Center (AMRTC) 

• Dave Lee, MA, LP, LMFT, LICSW, director, Carlton County Public Health & Human Services 

• Marc Martel, MD, emergency medicine, Hennepin Healthcare 

• Lisa Mattson, MD, national medical director, Optum 

• Jinny Palen, executive director, Minnesota Association of Community Mental Health Programs 

• Kristin Peterson, MSN, RN, CEN vice president of acute care and clinical operations, Children’s Minnesota 

• Michael Reese, MD, psychiatry, Mayo Clinic 

• Adam Riutta, MD, emergency medicine, Essentia Health 

• Michael Schwemm, MD, medical director, Allina Health, Mercy Hospital 

• Shamala Tamirisa, MD, medical director, PrairieCare 

• Amitabh Tipnis, MD, psychiatry, Allina Health, Cambridge Medical Center 

Former members of the task force include: 

• Casey Clements, MD, PhD, emergency medicine, Mayo Clinic, clinical practice chair 

• Carolyn McLain, MD, medical director, The Urgency Room, Twin Cities