The University of Iowa Hospitals & Clinic’s

Crisis Stabilization Unit

At many hospitals, it can take hours or even days for a patient to get psychiatric treatment. The University of Iowa Hospital and Clinics’ Emergency Department is changing that for the Johnson County area.

The university opened their new Crisis Stabilization Unit (CSU) in October 2018. But the CSU is more than a new space for psychiatric patients. It’s optimized for a better model of care known as the emPATH Unit–Emergency Psychiatric Assessment, Treatment, & Healing.  

Elaine Himadi, Director of Emergency Psychiatry Services, chose the emPATH Unit for its emphasis on empathetic rather than coercive care.

The model was developed by Scott Zeller, M.D. and Vice President of Acute Psychiatric Medicine at CEP America.

EmPATH Units are not alternatives to inpatient emergency department acute mental health patients. Instead, they are the destination for all of the emergency department’s acute mental health patients.

When patients with mental health concerns arrive at the University of Iowa Hospitals and Clinics they can expect to be evaluated, checked for medical issues, and transferred to the CSU for immediate psychiatric care. There, specially trained professionals give each patient a treatment only after a thorough psychiatric evaluation.

EmPATH Units are diverse in their designs and staffing but all of them follow a few key principles:

  1. There is an open design, with room for patients to move about freely, choose activities, and obtain food or drink or clean clothes without having to ask staff.
  2. There are no walls or glass “fishbowls” separating patients from staff. In emPATH Unit nurses, social workers, peer support counselors are always available and always nearby.
  3. The focus of these units is early assessment, with prompt treatment and supportive healing that is implemented properly and in the least coercive manner possible.

Dr. Jodi Tate, UI Vice Chair for Clinical Services in Psychiatry, said that, in the past, doctors were trained to do one of two things: discharge or admit their patient.  

“But now, we can observe our patients for 24 hours and then decide whether we’re going to discharge or admit,” Dr. Tate said.

Nationally, emPATH Units have been able to decrease the admission rate (of psychiatric inpatients) to 25%. Currently, UI Hospitals and Clinics admits about 50% of people who come to the ER. Their hope is to permanently decrease that to 25%.

“We try to address people’s basic needs first,” said Taylor Ford, Clinical Social Worker at the university’s CSU. “We ask them, have you eaten? Do you need a warm blanket? Do you want your clothes washed? I think a lot of that can get missed in the chaos of a hospital.”

“We’re very patient-centered,” said Dr. Tate. “A lot of choices get taken away when people come to the ER. We’re giving patients choices.”

Although it’s still early, the new CSU has already cut the average wait time from 30 hours to just ten. At the same time, it has already decreased the psychiatric inpatient admission rates from approximately 50% to 25% and increased the number of patients who are discharged or transferred in less than 24 hours.

Now when someone in the Johnson County area is experiencing an emotional crisis or psychiatric emergency the Crisis Stabilization Unit at the University of Iowa Hospital & Clinics gives them choices.

by Robert Davis