A quality improvement interrupted time series study evaluated whether embedding psychiatry-specialized nurse practitioners and support staff in the ED 24/7 (the Psychiatric Model of Care) reduced length of stay (LOS) for adults with psychiatric emergencies at a single urban academic medical center from January 2023 to December 2024 (n=5,222 encounters).
Median ED LOS dropped from 8.35 hours to 5.61 hours (adjusted median difference −1.64 hours; 95% CI −3.15 to −0.13); the greatest gains were in patients on 72-hour holds (−9.66 hours) and 14-day holds (−18.80 hours), and those transferred to psychiatric facilities (−4.80 hours); no significant difference was found for patients without holds or those discharged/admitted.
Single-center design at a tertiary urban academic center limits generalizability. Quality improvement study design (not an RCT) means unmeasured confounders and secular trends may explain some LOS reduction. Secondary outcomes such as patient safety, readmission, and staff experience were not reported.
Embedding psychiatry-specialized NPs and support staff in the ED around the clock can meaningfully cut LOS for psychiatric patients, especially those on involuntary holds awaiting transfer — the highest-acuity, longest-boarding group. EDs managing high volumes of psychiatric holds should consider dedicated, 24/7 psychiatric staffing models.
