24 Hours in the Psychiatric Emergency Room

Psychiatric emergency rooms (PERs) serve a unique and critical function within the mental health care system. Little information exists in the literature about day-to-day staff operations in the PER and the amount of time staff spend on different activities. We developed a protocol for unobtrusive staff observation to collect information on the amount of time spent doing activities such as clinical tasks and administrative tasks. This protocol was implemented at a busy urban safety-net PER which historically sees more than 4,300 patients per year. 24 hours of observations were completed during different shifts on weekdays and weekends. In total, 22 staff were observed including nurses, psychiatrists, medical students, mental health workers, psychologists, and residents. On average, staff spent 53% of their time on administrative tasks, 18% in direct face-to-face clinical contact, 9% on the phone, and 20% of time on other activities, Although the distribution of activities did not change across shifts or days of the week there was large variation in the distribution of activities among staff roles. These findings will increase knowledge about workflow and staff functions in the PER and provide a unique perspective from which to develop further research questions regarding PER workflow.