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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
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Welcome to should I Call a
Doctor, the podcast where we
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dive into the questions you have
about your health and today's
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trending health topic to
separate fact from fiction.
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I'm one of your hosts, Doctor
Samuel Gauley, an internal
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medicine physician at Inova.
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I'm Tracy Schroeder, I lead
communications for Inova.
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Doctor Sam will give you the
clinical perspective while I ask
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the questions that keep patients
up at night.
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Welcome back for another episode
of should I Call a doctor?
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Today we're diving into
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something that's changing the
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way we care for people in mental
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health crises.
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The Empath unit.
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Thanks, Tracy.
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Well, empath, it stands for
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Emergency psychiatric Psychiatry
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assessment, treatment and
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Healing.
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Um, it's a pretty innovative,
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patient centered model for
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psychiatric emergencies.
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Um, with the idea being that
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it's focused on providing a
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calming therapeutic environment
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with the goal of improving
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patient outcomes, safety and
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satisfaction.
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Um, for our listeners, I'm sure
you're aware that mental health
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is a pretty hot topic, has been
for a long time, particularly
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since the pandemic five years
ago, um, which was not a small
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driver of, of, of where we're at
today and discussions around
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things like NFTs.
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I'm excited to invite and have
join us.
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Doctor.
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Rachel Bronster did I say that
right?
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Yes you did.
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Yes.
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So welcome.
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Rachel.
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Please go ahead and introduce
yourself.
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You can do it better than I can.
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Uh, so I'm Rachel Bronster.
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Um, thanks for having me.
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Uh, I am board certified in
medicine and psychiatry.
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I am currently the chair of
Fairfax for psychiatry.
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Uh, and I oversee our units for
the system as well.
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So I'm also division chief of
adult psychiatry.
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So for our whole system as well.
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Um, and I'm excited to be here.
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Oh, it's great to have you.
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So I did a probably pretty
boring job of saying what I did.
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I literally just said it, what
it stands for.
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Maybe you can tell us exactly
what it is.
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Um, what need does it serve?
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Like what, what actually drove
creating a unit like this.
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And how is it different from a
traditional emergency room?
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Sure.
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So I mean I think it's multi
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factor a lot of factors
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involved.
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One of them is a shortage of
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beds inpatient beds to begin
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with.
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The other is our emergency rooms
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are really overcrowded with
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psych patients.
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Um I think nationally it's like
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ten or fifteen percent of all
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E.R. patients are psychiatric
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patients.
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And I can tell you, as I'm sure
you know, there are days it's
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more than that at Ras.
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Um, which is of course,
especially Fairfax being, I
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think, third or fourth busiest
year in the country.
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We're talking about a really big
number of patients.
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Um, and I'm sure it's, I don't
have to go into detail to
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explain that the E.R. is not a
perfect place for psych patient
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to spend a lot of time.
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Um, so, so for both of those
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factors, we don't have a ton of
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rooms.
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There are more psych patients
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than ever, and the wait times in
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the ER are becoming longer than
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ever.
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Um, so this is a, this is sort
of in between a lot of the
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options that we currently have.
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I mean traditionally it's sort
of your inpatient or outpatient,
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um, the empath unit more
specifically, is really for our,
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uh, not quite well enough to go
home and not quite sick enough
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to need to stay a few days.
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And so these folks who,
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especially when they're waiting
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in the ER for, I mean, hours, I
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mean, you know, the wait time
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has been twelve plus hours at
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times just to see a psychiatric
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provider at any acerbate a
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condition too.
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Absolutely.
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I mean, and people leave, um,
people also get worse.
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I mean, it's such a, it's an
aggravating place to be.
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Yeah.
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Uh, and also it doesn't
necessarily have exactly the
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services they need.
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So as a physical location, it's
a pretty stressful place.
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Yeah.
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Um, but also who's actually
taking care of the patient is
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another big question that always
comes up is who's available?
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What are the resources, not just
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the environment itself and the
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training.
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Right.
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Exactly.
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Folks who want to work in the
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ER, not necessarily, uh, don't
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necessarily have a ton of
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training with psychiatric
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patients.
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And frankly, it's often not
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their interest, not their
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primary interest.
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So it's not the type of
intensity they're looking for.
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The psych patient, you know,
it's not the same as a trauma
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inciting trauma or something.
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So how does empath aim to
address all of this and kind of
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introduce something different
and provide that, you know, sort
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of middle ground that can really
be catering to these people that
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come to us in crisis.
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So I, in an attempt to explain
it to some people, I've sort of
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explained it as like a
psychiatric OBS unit, but it's
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not exactly that.
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It's that the stay is similar to
an OBS say that we're looking at
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about twenty four hours, forty
eight hours max for a patient.
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What's an OBS day observation?
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An observation stay, which is on
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the medicine side kind of in
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between inpatient and
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outpatient.
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So like a short it's a short
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like a short stay, usually not
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very high intensity or service
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type.
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Yeah.
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Like a quick rule out of chest
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pain, heart attack kind of
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thing.
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Go home.
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Um, this is a much more calming
environment than a regular
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medical floor would be.
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Or our ODS unit for medical
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patients look like it's an open
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milieu.
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So we're looking at really a lot
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of recliners actually in an open
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space.
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We have the ability to give
people some privacy,
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particularly at night.
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And there's some private rooms
for folks who just need to be by
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themselves for a minute.
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Um, and it's, it's nice,
frankly, it's nice.
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It's really beautiful.
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We have, you know, beautiful
windows.
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Uh, there's snacks and things
like that.
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Patients can always help
themselves to easy bathroom,
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easy access to everything.
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Um, it's much less restrictive
than our inpatient unit.
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Uh, but we're working on some of
the details in terms of letting
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folks use their phone and things
like that, like on a psych unit.
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There's no electronics.
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You have very limited visiting
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hours, you know, things of that
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nature.
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We're trying to make this a lot
more comfortable for folks.
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Um, there are some HIPAA things
we have to keep in mind with
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cell phones, but we're we're
working through it.
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And, and I think it'll be a. So
open space, meaning like the way
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it's actually designed is you
said, okay, so you have
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recliners, but it's, it's like a
public ish type space.
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You have some private room
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options, but the patients
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actually don't have their own
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private.
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I mean, imagine kind of like a
first class chair kind of thing
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that goes all the way, you know,
it's really nice.
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Um, but during the day, you
know, we want people engaged.
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We want it to be, we don't want
there to be a lot of downtime.
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I mean, we're trying to get a
lot done in a really short
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period of time.
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We have groups throughout the
day.
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So different types of groups are
just about to ask what happens
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while they're there.
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So a lot, a lot in a really
short period of time.
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Um, we have groups throughout
the day.
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Things like pharmacies, running
groups.
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We have a large group of
therapists who are down there
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helping people, um, you know,
process different things, coping
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skills, things of that nature.
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Um, you know, even just talking
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about what outpatient resources
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are out there and what care
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might look like, especially for
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our folks who are coming new,
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um, or just entering the mental
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health into mental health
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treatment.
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Um, so it's very informative.
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Um, the other thing that's
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happened is everybody's meeting
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with a social worker rather
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there.
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And I think this is probably
the, the biggest piece of it is
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that we create these really
robust after care plans.
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That's really what's so useful
about the difference between
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going home from the emergency
room or coming inpatient is,
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yeah, the five or six days you
spend on inpatient, I can get
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you on meds.
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I can make sure you tolerate it.
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I can make sure you know, you
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know, what your strengths are in
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terms of coping skills, but it's
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the beginning of your care, not
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the end.
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What's really the big treat of
being inpatient is all of a
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sudden now you have a
psychiatrist, a therapist, maybe
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you're in a PHP.
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I mean, and, you know, I'm sure
you know, I don't have to tell
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you guys or folks who are
listening to this.
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I mean, kind of get a
psychiatrist on your own right
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now is ridiculous and is a is
exceeding the supply.
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You know, it's, it's really hard
to get folks in.
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So having the, a pipeline to
outpatient care, um, strong
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outpatient care not only keeps
patients out of the hospital,
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but it helps them get better.
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I mean, that's really where you
heal, right?
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Um, the inpatient unit is more
of like a psychiatric ICU.
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It's always that question of,
okay, what's the next step?
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How rapidly and easily Can I
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ensure you have access to follow
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up care?
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Is there anything about that
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that has changed with the empath
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unit?
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So, uh, we have created some
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partnerships with folks in the
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community as well where they
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actually have been able to
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create, um, like online forums
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for us to be able to put a
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referral in, you know, in eleven
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o'clock at night and they've
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guaranteed a certain and a
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certain amount of time, they're
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going to get them in to see
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somebody.
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Oh, well, the other thing we
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have is iPAC, which is
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essentially a, again, another
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acronym.
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I probably don't remember what
it's for.
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It's essentially urgent care for
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psychiatry, which we have over
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at Merrifield.
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Um, and we've been able to
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create basically a bridge for
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anybody.
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We can't get in right away to
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say partial hospitalization
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program.
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We'll visit so they can do a
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visit or two there and that we
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can arrange after hours as well
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because it's within our own
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system.
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Um, so it's not the, but that's
actually really helped
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streamline some of the referrals
to the community and even within
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our own system.
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Um, and so I think that's
helpful.
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I think, uh, the other thing
that it's really helped is,
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well, let me take a step back.
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I mean, I think what we lack in
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mental health traditionally is
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kind of that in between the
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inpatient and outpatient is
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there's clearly folks who are
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really sick but don't need to be
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in an ICU level of critical
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care.
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Right.
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And so this is just one of those
aspects that's filling in that
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gap of in between.
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Um, and a really nice
progression for these folks is
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you come to empath, you get that
nice aftercare plan and a
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referral to like a PHP or IOP.
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Those I do remember so good or
Diego.
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So remember HP is partial
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hospitalization programs,
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partial hospitalization
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programs, intensive, outpatient,
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intensive outpatient.
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So PHP is usually about two
weeks, five days a week.
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You're looking at groups
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throughout the day, same kind of
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thing.
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You get an empath or inpatient,
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you're meeting with providers,
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you have therapists, things like
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that.
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Um, IOP is similar, but it's
only three times a week.
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Okay.
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So it's, it's like a step down
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and it's that step down from the
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air that we just had a lacked, I
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think, for a long time in mental
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health.
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And now just helping the people
listening understand sort of the
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role that empath plays.
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Do you come when you're
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observing or experiencing a
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mental health crisis in your
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home or your, you know, day to
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day environment?
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Do you come and check yourself
into empath?
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Do you go to the Ed or is it
more that you've been in the
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hospital and this is the step
you do before you, uh, get
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discharged or is it both?
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That's a great question.
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Um, we're working on direct
referrals specifically from
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iPAC, our urgent care.
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So you can kind of bypass the Ed
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we do require folks get
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medically cleared.
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Uh, you know, we are primarily
staffed with psychiatric team
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making sure let's, let's rule
out that heart attack.
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Exactly.
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See us.
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We have everyone go through
triage at least, um, through the
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regular er, a lot of folks just
get some basic labs and EKG.
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It doesn't need to take that
much time.
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And after they get that, you
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know, are you seeing someone
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come and go through triage come
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to you guys, you know, does the
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empath unit.
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How does it staff during the day
versus at night?
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Like you mentioned, groups and
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stuff, but a lot of times these
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things happen, you know, late at
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night or in the middle of the
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night.
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And how do you how do you
respond to that?
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Or how does the empath unit set
up to respond to that?
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Sure.
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And that is a little different
from our inpatient unit.
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I mean, we have providers that
are twenty four hours a day.
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Uh, pretty much the same amount
during the day.
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And that as at night, we found
that really between like three
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and eleven is when psych
patients really like to show up
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to the ER.
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So for the night.
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Yeah.
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Right.
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I think it's, it's a popular
time, unfortunately.
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Um, so we try to staff to
volume.
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Yeah.
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Um, but the difference is you're
actually going to see a
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psychiatric provider that night.
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When you get there, you're going
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to have that psych eval, you
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know, within an hour or two of
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getting there.
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I mean, that is a game changer.
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Yeah.
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What's the biggest impact or two
or three that you've seen since
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this unit is opened?
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Yeah.
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Actually have patients waiting
less in the ER or happier
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patients or whatever it is.
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I think, well, a lot of people
are happier.
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I think particularly our ER
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colleagues are much happier
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because we're getting patients
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to places where long is a strong
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word.
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But you know, getting patients
to the right place, getting them
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the care they need without a
million steps in between and
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under the service of the person
who's best equipped to do so.
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Going back to what you said with
the ER, like you can have a
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psychiatry trained professional
caring for a patient at one
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o'clock in the morning versus
the er physician, you know,
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obviously equipped to do a part
of er medicine has to deal with
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emergencies but it's not the
same of course.
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And also has other things that
they're trying to deal with.
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You're making the patient
happier.
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It's, you're making the, the,
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the caretaker happier, providing
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better care.
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So you're seeing that.
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Yeah.
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And I think yeah, obviously
bedside staff.
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I mean, this is staff with
psychiatric nurses.
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These are nurses who have not
only have experience with
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psychiatric patients, but this
is their preference.
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You know, that was what they'd
chosen.
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Are you seeing patients come in
with everything from sort of
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high anxiety and panic attacks
and elevated blood pressure.
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You know, all the way through
to, you know, maybe more manic
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episodes or like bipolar
instances or things like that.
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Is it really running the gamut
in terms of the patient care
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that you're having to do?
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Uh, it is though the acuity is
not as intense as inpatient.
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So there are a couple things,
couple requirements that we, you
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know, patients have to be
voluntary to begin with.
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And our inpatient unit, a number
of patients, um, are
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involuntary, which means, you
know, their loved ones or the
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police, um, have said that their
danger to themselves or others,
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they have to be there.
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All of these patients are
voluntary.
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So that immediately kind of
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decreases some of the acuity
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because we're talking about
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folks who have insight, folks
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who say there's something wrong
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with me.
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You can say it's an open unit.
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So the danger to self or others
is not going there.
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You know, I don't want to get
that help.
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People who want to get that
help.
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People know they're going to be
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there with other people who are
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sick, uh, who are eager to have
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that, you know, that robust
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aftercare plan.
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And is it appropriate for
pediatrics and for adults?
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Or are you seeing that it's it's
more you're seeing all or you
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really just see adults maybe ask
me like a year or two.
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So it's still new and it's one
of the first in, in the country.
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So we certainly can't have
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adults and, and kids in the same
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environment.
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Right.
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Um, so maybe sixteen and up, we
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could open it up to down the
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line.
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Um, but we are finding, I mean,
what we haven't talked about is
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of course the mental health
crisis amongst the youth.
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That's just, I mean, exploding.
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Yeah.
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Um, so we are in talks of having
something similar for our kids.
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Um, and the reality is kids wait
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for beds even longer than adults
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do because there are so few in
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our area.
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Um, so, so yes, but not yet.
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Have you, um, received feedback
from patients on this unit?
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Yeah.
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And either patients who this is
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the only hospital experience or
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even more interestingly, someone
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who's like, I've actually seen
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the other side where I've waited
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in an E.R. for forty hours or
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I've been admitted to the
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inpatient setting.
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Have you had that perspective
from patients, folks who have
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been in inpatient
institutionalized for a lot of
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their life, who are coming in
with, um, suicidal ideation?
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I'm thinking about ending my
life, but overall risk factors
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are, are, you know, maybe you're
at a moderate risk.
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It's not, it's not imminent.
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And so for folks who have been
inpatient before, spent hours in
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the ER, kind of somewhere in
between is really refreshing.
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Is my understanding.
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I think they feel like they're
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being treated with more respect
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than a more appropriate
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environment.
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That's wonderful to hear.
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So we're wrapping up with our
time here.
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Tell us a little bit about if
someone's listening and
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wondering if their circumstance
warrants the impact unit.
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Yeah.
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What would you tell them?
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I think if you think you might
need help, go get it.
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I think if you're at a point
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where you're like, not sure, the
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answer is, is that you're ready
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for it.
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Um, you know, the degree of help
that you're willing or open to
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getting it depends.
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Everybody's at a different
place.
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I think empath does a good job
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of meeting people where they
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are.
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It's not as dramatic as taking
weeks off of work and things
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like that, but it's a really
good way to jump start care.
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Um, and the reality is, is that
people who think they need help
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usually need help.
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Usually need help.
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Yeah.
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It's such a cool name too.
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Yeah.
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It's very, we're like, you said
Speaker:
it like twenty times on this
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podcast.
Speaker:
And as we keep saying it, I'm
just like, you know what?
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There's just something really
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warm about the name, even as I
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keep saying it, even if I can't
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remember.
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Sure.
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There's an effect.
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Yeah.
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We realized, but if the best
acronym we've used.
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Yeah, yeah, yeah, it necessarily
very innovative solution for
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something that is touching so
many lives these days.
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And so really happy that we're
doing this and that we can make
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this care available to the
patients in Northern Virginia.
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Absolutely.
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Thank you so much.
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Thank you for having me, I
appreciate it.
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Thanks for tuning in.
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