January 2, 2018
Darlene Scafiddi, MSN, RN
Vice President Nursing
Pomona Valley Hospital Medical Center


Pomona Valley Hospital Medical Center


What is it ?



  • Psychiatric Assessment Treatment and Healing Unit
  • Quasi Crisis Stabilization Unit 

What is it?


  • Method to enhance the care that will provide a middle-ground treatment method where patients will be evaluated, discharged and transferred to the proper outpatient treatment program or inpatient treatment facility within a 20-hr stay
    • Best practice for Psychiatric patients
    • Short term outpatient Psychiatric care
  • Improve the Care we provide to Psychiatric patients
    • Types of patients will be treated
      • Those exhibiting a psychiatric emergency
      • Age 13 yr & over
      • Alcohol or drug-related



  • We are unable to meet the needs of our Psychiatric patients !!
  • Decrease in quality of patient experience due to lack of designated area for psychiatric patients. Currently our psychiatric patients are intermixed with pediatric patients, critically ill patients and patients experiencing traumatic events.
  • 8-10 Psychiatric patients a day in our ER
  • Long length of stays
  • Excessive sitter hours
  • Low patient and family satisfaction
  • High percentage of repeat patients
  • Impact on entire Ed population
  • Decrease in treatment space capacity due to long lengths of stay
  • Delay in care
    • Psychiatric meds not started timely
  • Associate injuries
  • Placement in psychiatric facilities difficult
  • Limited psychiatrist services
    • Treated by ED MD’s

Current State:

  • In 2017 a total of 1337 Behavioral health patients with a length of stay of 26,436 hrs.
  • A total of 18,168 sitter hours were used in the ED
  • Suboptimal environment for patients with mental illness
  • Safety concerns for both staff and patients while waiting for care in the chaotic ED environment
  • Psychiatric symptoms escalate creating the need for behavioral restraints or sitters
  • Delay of psychiatric care for the patients due to limitation of psychiatric services in the ED and lack of psychiatric bed placement options.
  • Caregivers lack of confidence in skill and expertise for the patient population
  • Lack of available psychiatric providers to evaluate patients and place on required medication


Qauisi Crisis Stabilization unit

  • Use ED 4
    • 10 beds
    • Locked unit
    • 1:4 nurse ratio
    • Not relicensed by the state
    • Remains part of Ed outpatient space
    • Patients start out in Ed
    • Received medical evaluation and are moved to Ed 4



  • Convert our existing ED-4 area:
    • Large, open space where patients can be together in the same room – high ceilings and ambient light, 8-10 recliner chairs
    • 1-2 separate gurneys area for any patients needing private treatments, to remove person with outburst, etc.
    • Open nursing station with instant access to staff
    • Nutrition/Break room
    • Private Bathrooms
    • Medication dispenser
    • Group televisions
    • Panic alarms and cameras


  • Nurse Staffing ratio 4:1
  • Remain under the ED Leadership team consisting of medical director and nurse supervisor/director
  • Patient Navigator
  • 24/7/365 Psychiatric RN
  • 24/7/365 Psych Tech – ADL’s, group meetings, etc.
  • Social worker
  • 1 24/7/365 Clerical
  • 24/7/365 Security
  • Will accept patient from PVHMC ED once medically cleared.
  • No direct admits or ambulance directly to unit. 

Clinical Admission Protocols

  • Addresses current physician shortages challenges
  • Access to a 24/7 board certified psychiatrist
  • Can be utilized in diverse care setting such as ED, ICU inpatient area
  • Improved ED capacity and throughput with more timely care
  • Integration with providers across care settings
  • Decrease of up to 80% of mental health patient boarding time.
  • Can reduce cost associated by inappropriate in-pt. admission
  • Provides a full evaluation, risk assessment, diagnosis, treatment, and disposition recommendation.
  • Overcomes need to have face-to face psychiatrist available 24/7/365
  • Cost saving substantial versus keeping ED manned with a psychiatric consultation at all times
  • Telemedicine makes it possible to handle emergencies in a distributed area without psychiatrist traveling
  • Can provide targeted pharmacologic management that works quickly without sedation (currently used by EDMDs) which delays disposition.
  • Decreased liability that makes it easier for EDMDs to evaluate suicidal patients
  • Metrics
    • Response time
    • Look at quality of documentation
    • Review patterns of dispositions
      • Based on AAP guidelines

Tele Psy

  • Web based program
    • Two way communication with patient
    • Response within 30 minutes
    • one on one Tele Psychiatric consult   within 2 hours
    • Follow up if needed

 Other CSU’s

  • Beverly Hospital
  • Citrus Valley-exploration phase
  • Exodus
  • San Pedro
  • Palomar
  • Providence Little Company San Pedro
  • Riverside County


  • For Profit company
  • Awarded the County RFP
    • County funds
  • They will take medically cleared transfers
  • Opening a 14 bed Psychiatric Urgent Care
    • City Of Industry
    • Opening 2018

Next Steps

  • Contract CEP (California Emergency Physicians)
    • MD credentials
      • 12 Board certified Psychiatrists
      • Members of the American Academy of Psychiatry
    • Refurbish the Unit
      • TV’s
      • Refresh
    • IT Infrastructure
    • Continue to work with HASC task force
    • Continue to work with county
    • Work with IEHP
    • Recruit and train staff
    • Develop policies and procedures
    • Propose Opening March 2018