Minnesota
Minnesota mental health patients stay 25 hours longer than necessary in ER because of shortages
When patients in mental health crises get stuck in Minnesota’s emergency rooms, they stay 25 hours longer on average than necessary — taking up hospital space as well as the time of doctors and nurses, who could otherwise focus on the next emergencies.
Researchers documented the length of these delays by studying patient activity over 14 days last fall at more than 30 Minnesota hospitals, but they also provided vital evidence about which patients were most likely to suffer delays, and why.
Knowing which patients are at risk can help the state come up with treatments that target this population and prevent mental health crises and hospital visits, said Kristin Dillon, a coauthor from Wilder Research, which released the report on Monday along with the Minnesota Department of Health.
Delays for patients “in a hospital setting when they can be discharged is harmful to patients, caregivers, hospital staff and the health care system,” she said. “However, we cannot take steps to effectively address these discharge delays without understanding the underlying reasons behind the delays.”
Monday’s findings were presented to an advisory council created last year to reduce delays in care and the worsening problem of ER and hospital overcrowding in Minnesota.
Staffing and bed shortages at nursing homes and rehabilitation centers have worsened since the COVID-19 pandemic, leaving hospitals stuck with frail, elderly patients on their inpatient floors. Twin Cities ERs have treated patients in hallway gurneys at peak times when they have run out of beds. But these delays in many ways just compounded the longstanding problem of patients in mental health crises being boarded in ERs with nowhere to go.
Hospital inpatient psychiatric units were largely full during the study, and they couldn’t take new patients from ERs until they found space to discharge their existing patients to residential or outpatient treatment programs. The study observed 182 patients in hospital psychiatric units whose discharges were delayed, and on average it took 8 days longer than necessary to move them.
The problem was more complex than patients waiting for openings in treatment programs, though. One in five patients stuck in inpatient units was delayed by court decisions over civil commitments, or decisions over their eligibility for insurance benefits or waiver programs, the study showed.
Among patients stuck in ERs, only six in 10 needed inpatient hospital care. The rest were stuck for other reasons, including delays in arranging transportation home or in getting outpatient care lined up. A third of the delayed patients went straight home from the ERs.
M Health Fairview has been confronting the problem, opening a so-called EmPATH unit at its hospital in Edina that provides a relaxed environment and transitional care for patients who can be moved from the ER. The health system also is partnering with for-profit Acadia Healthcare to reopen the Bethesda Hospital campus in St. Paul as a psychiatric facility next year.
In some ways, the delays published in the report underestimated the problem. Delays were only calculated for patients who were discharged during the two-week study. About 5% of the ER patients had yet to be discharged by the end, and some spent the entire two weeks in care. Some hospitals have endured extreme cases, such as the boarding of a child with behavioral problems for months at Ridgeview Medical Center in Waconia.
State lawmakers were so concerned by the delays in 2022 that they waived Minnesota’s hospital construction moratorium through 2027 for any provider looking to add psychiatric capacity. However, the study makes it clear that the greatest need is in community and preventive treatment programs that keep people from crises, said Dr. Will Nicholson, vice president of medical affairs for Fairview’s East Metro hospitals.
“We can take better care of people when we can prevent illness, we can get upstream,” he said.
Minnesota has been locked for two decades in a chicken-egg debate about whether to spend limited dollars on more inpatient beds, or preventive programs to try to reduce the need for those beds. State health economists blocked a proposal in 2008 by then-named Prairie St. John’s to build a psychiatric hospital in Woodbury, based largely on the argument that prevention programs were needed more. The provider later became known as PrairieCare and built and expanded a pediatric psychiatric hospital in Brooklyn Park.
More beds aren’t the only solution at a time of workforce shortages, said Sue Abderholden, who directs the Minnesota chapter of the National Alliance on Mental Illness. Minnesota previously tackled the mental health treatment shortage by creating a stepdown level of care called intensive residential treatment services to ease the pressure on hospitals. The state has about 60 of them operating, but many can’t find enough staff and are operating well below their 16-bed capacities, she said.
The legislature this year OKed funding for counselors who could check on patients who were showing the first signs of struggling — perhaps by skipping medication doses or appointments, Abderholden said. “We’re trying to get way before a crisis, before you need an ER, before you need a crisis team.”
Could a UCLA baseball team that’s perfect in Big Ten play get better?
Bruins coach John Savage thinks so, which is a frightening prospect for the rest of a seemingly overmatched conference.
While Savage’s top-ranked Bruins completed a three-game sweep of Minnesota on Sunday with a 5-2 victory at Jackie Robinson Stadium — stretching their Big Ten winning streak to 21 games — he said there’s more upside to be realized.
“Offensively, we just really couldn’t get a lot going,” Savage said after his team went 1-for-5 with runners in scoring position and stranded six baserunners. “We just weren’t able to put a lot together, but when that pitching and defense shows up every day, it gives yourself a chance to win, and that’s kind of what we did all three games, really.”
Those elements were so good Sunday that they overshadowed Roman Martin’s solo homer in the third inning and Will Gasparino’s two-run shot in the sixth.
Bruins left fielder Dean West made three superb catches — two leaping and one diving — and four relievers combined to give up only one run in 4 ⅔ innings. Closer Easton Hawk needed only six pitches to record a 1-2-3 ninth inning while notching his third save in as many days.
Savage credited Minnesota’s pitching after the Golden Gophers (22-17 overall, 5-13 Big Ten) held the Bruins (36-3) to an average of five runs during the series and said many of his team’s offensive struggles were situational.
“We have very, very good offensive players — some of them are in … little ruts right now, but that’s OK,” Savage said. “These guys play a lot and get a lot of at-bats; there’s a lot of ups and downs.”
When it comes to UCLA’s conference record, it’s all been up.
What it means
UCLA’s sweep is further evidence that the Bruins aren’t getting complacent because of their record.
“This culture is really solid, and these guys truly believe in one another and they’re playing for the team,” Savage said. “We’re very fortunate to have this group, and so they love playing together, so there’s no complacency and there’s no reason to because we haven’t done anything; I mean, you’re 36-3, that’s great, but at the end of the day it’s about getting better and playing your best baseball the next 75 days.”
Turning point
Spotting a dominant team an early lead is never a good idea.
That’s what happened when the Bruins struck for two runs in the bottom of the first inning.
West led off with a single to center field, took third on Roch Cholowsky’s double to left and scored on a balk. With one out, Martin hit an RBI infield single off the pitcher’s glove. UCLA was up 2-0, and the Golden Gophers could never catch up.
Did you see that?
Minnesota did not like it when Gasparino admired his home run by lingering in the batter’s box before commencing his trot around the bases.
There was consensus in both dugouts because Savage also didn’t care for it.
“I thought he probably stayed in the box a little too long for me,” Savage said. “That’s kind of not who we are, and they didn’t like that; I wouldn’t like that either, really.”
MVP
West saved multiple extra-base hits with his catches.
Which was his favorite?
“Probably the diving one,” West said. “I think that was the coolest one. I got to leave my feet and make a play on it.”
Up next
The Bruins will open a five-game stretch of nonconference games when they host Hawaii on Tuesday evening at Jackie Robinson Stadium.
Of the many terrible roster decisions Minnesota sports teams have made over the past 30 years, the worst of the bunch may have been trading Randy Moss to the Raiders for the No. 7 pick in the draft and linebacker Napoleon Harris.
Why are we bringing up a trade that happened 21 years ago? Because the New York Giants traded defensive tackle Dexter Lawrence to the Cincinnati Bengals for the No. 10 pick in this week’s NFL Draft. It was the first time a non-quarterback has been traded for a top-10 pick since the infamous Moss trade in 2005.
Minnesota traded Moss for the Raiders’ first-round pick, Harris, and a seventh-round pick on March 2, 2005. The Vikings used the No. 7 pick on wide receiver Troy Williamson, who never panned out in the NFL. He had 24 catches for 372 yards and two touchdowns as a rookie, 37 receptions for 457 yards and zero touchdowns in 2006, and just 18 catches for 240 yards and one touchdown in 2007.
Williams led the league with 11 dropped passes in 2006. Minnesota traded him to the Jacksonville Jaguars for a sixth-round pick after the 2007 season, where he played in 10 games over two seasons and totaled just eight catches for 64 yards. He was cut before the start of the 2010 season, and that was a wrap on the former South Carolina speedster’s NFL career.
Moss didn’t put up jaw-dropping numbers with the Raiders for two seasons, but he set an NFL record with 23 touchdown catches in 2007 with the New England Patriots. He caught 47 touchdowns in 48 regular-season games with the Patriots from 2007 to 2009.
Whether it was trading Moss to the Raiders, the Timberwolves sending Kevin Garnett to the Boston Celtics — or drafting Ricky Rubio AND Johnny Flynn over Steph Curry — or the Twins cutting David Ortiz and watching him become one of the greatest players in MLB history with the Boston Red Sox, Minnesota sports teams have a long history of making terrible decisions.
The Bengals, meanwhile, gave up the 10th overall pick for one of the best defensive tackles in the league. They’ll likely get great production from Lawrence, while the Giants are now under pressure to get the 10th pick right. New York also holds the No. 5 pick in Thursday’s first round of the draft.
By the way, the Vikings had two picks in the first round of the 2005 draft. After taking Williamson, they used the No. 18 pick on defensive end Erasmus James. He was just as much of a bust as Williams, playing in 23 games in three years with the Vikings. He had four sacks as a rookie, but injuries wiped out most of his 2006 and 2007 seasons before he was traded to Washington for a conditional seventh-round pick.
James was cut by Washington in December 2009, marking the end of his NFL career.
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Kirill Kaprizov had a goal and two assists, and Ryan Hartman had a goal and an assist for the Wild, who are the No. 3 seed in the Central Division. Wallstedt made 27 saves in his Stanley Cup Playoff debut, and Zuccarello had three assists.
“I was definitely nervous,” said Wallstedt, a rookie. “I think it shows that it means something to you. I like a little bit of nerves. I think it’s something good. There were definitely some nerves throughout the day and then a little bit extra rolling into the game. But after the national anthem was over and the first couple pucks started coming, you’re good.
“I wanted to play and I felt like I have been going good. I was a little surprised (to get the start). But I was very excited as soon as I got the news. I just wanted to make sure I was ready today.”
Jason Robertson scored, and Jake Oettinger made 23 saves for the Stars, who are the No. 2 seed in the Central.
“We didn’t deserve to win,” Dallas forward Mikko Rantanen said. “I think two power-play goals for them, two a little-bit bounces for them where we had guys in the right spot. Just even keel. Playoffs are like this. Sometimes you lose a game, you can feel like you’re done. But that’s the mentality you need to have, you’ve got to reset and learn from mistakes.
“First 30 minutes, we didn’t win enough battles. They were just that little bit stronger in the battles and that’s why they were able to make us defend more than we want to. Just got to be stronger.”
Game 2 is here on Monday (9:30 p.m. ET; FDSNWI, FDSNNO, Victory+, ESPN, TVAS2, SN360).
“We prepped for a couple days coming into this one. Now, we will gather information from this game and continue to move forward,” Minnesota coach John Hynes said. “For me, it’s game to game and day to day. We want to continue to get better. We won and they [Dallas] lost. It’s not so much being satisfied where you’re at or that’s what it is. We need to continue to find ways to get better.”
Eriksson Ek gave the Wild a 1-0 lead at 5:35 of the first period on the power play. He scored on a one-timer from the left hash marks to finish a tic-tac-toe passing play with Zuccarello and Boldy, who found an open Eriksson Ek with a pass from the goal line.
“I think every team in the playoffs talks about not getting too high or too low. Just enjoy every day and each game and then we will go from there,” Eriksson Ek said. “I think we played pretty good today. The next game is a new game, so we just have to do it over and over every game. We know they are probably not the happiest with that game, so I am sure it’s going to be hard next game.”
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