Policy Interventions to Improve Inpatient Mental Healthcare Access: A Discrete Event Simulation Study

Abstract: For a large portion of mental health patients, the Emergency Department is the first point of contact when in crisis and in need of urgent acute care. Unfortunately, those who have already received an admission disposition may wait hours or days after before being placed in a psychiatric inpatient (IP) care unit. Known as ED boarding, one primary contributor is the inability to locate an available IP bed for transferred patients. In this study, we develop a discrete event simulation modeling patients arriving at numerous EDs throughout the region, as they're either internally placed in a psychiatric IP care unit or externally transferred to an IP unit located outside the ED they originally arrived. This simulation is then used to investigate the effect of three proposed interventions to the IP bed placement process on key performance indicators like patient treatment delay, a metric incorporating both the patient's ED boarding period and time to travel to their eventual IP destination.