Creating Flexible Treatment Spaces
Improving patient safety during behavioral health emergencies
- By Siva Davuluri
- June 01, 2021
Teaching hospitals and emergency
medicine residency programs face a
variety of challenges in treating
behavioral health patients. Chief
among them is creating a safe environment
that protects patients and staff.
This is an increasingly urgent issue as
healthcare systems continue to deal with a
sharp rise in behavioral health-related
patients. According to recent data from the
National Alliance on Mental Illness, one in
eight emergency room visits by U.S. adults
involves mental illness or substance use disorders,
with an estimated 12 million visits
Amid the pandemic, those numbers have
only increased. The Center for Disease Control
(CDC) reported that in June 2020, rates
of anxiety were approximately three times
higher and depression cases were approximately
four times higher than the year prior.
According to the report, younger adults,
racial/ethnic minorities, essential workers
and unpaid adult caregivers are disproportionately
aflicted with worse mental health
outcomes, increased substance use and elevated
Behavioral health education in institutions
across America provides future practitioners
with well-rounded training to treat
these kinds of issues. But for residents in
emergency departments, the resources are
fewer and further between. That’s because
emergency medicine wasn’t designed to specialize
in behavioral health issues, and yet,
due to a number of converging societal factors,
emergency rooms have become treatment
facilities for many patients who have
nowhere else to turn.
A report by the Agency for Healthcare
Research and Quality revealed that emergency
room visits related to mental health
and substance-use issues increased more
than 44 percent from 2007-2013, with visits
from patients suffering suicidal thoughts
growing by a devastating nearly 415 percent.
Aside from the lack of psychiatric training
for emergency medicine doctors and residents,
however, is the compounding issue of
the facilities themselves: most emergency
departments are not physically equipped to
deal with behavioral health emergencies the
way that inpatient behavioral health facilities
are set up.
That is even more concerning when you
consider the trend of emergency department
“boarding”—where behavioral health
patients remain in emergency care rooms
a er being admitted, waiting to be transferred
to an inpatient unit. According to one
study, behavioral health patients spend 42%
more time waiting in the emergency room
compared to other patients; their wait times
average out at more than 11 hours. That all
adds up for patients, doctors and residents
and increases safety risks for everyone.
Equipping Facilities for Safety
Psychiatric cross training is slowly beginning
to work its way into emergency departments
and emergency medicine residency programs.
But facility managers and safety committees
in teaching hospitals also have a
responsibility in protecting occupants by
ensuring facilities are up to date with the latest
building safety technologies and trends.
Some industrial rolling door manufacturers
are introducing new products into the
market specifically engineered to make spaces
like emergency departments safer and
more secure for patients and staffalike, creating
flexible spaces that can transition
seamlessly from behavioral health to emergency
Advanced new ligature-resistant counter
doors can deploy with the mere press of a
button, converting standard exam,
diagnostic or emergency care rooms and
treatment bays into safe spaces for patients
suffering an acute behavioral health issue.
These doors can cover cabinetry,
pharmaceuticals storage, countertops, computers, medical equipment and other potential ligature points
that can be used for self-harm or against medical staff, all with a
single rolling steel door. The doors can be finished to match the
surrounding, or designer can pick a color that provides calming
ambience for patients while waiting to be seen.
Constructed of steel or aluminum, some products offer impactand
tamper-resistance while meeting ASHRAE/Facility Guidelines
Institute (FGI) recommendations for exam rooms. The key for
behavioral applications is to ensure fasteners are concealed and
have no grab points or pinch points, eliminating potential points of
“This technology offers staff the flexibility to change rooms around
with the functionality to treat mental and physical ailments in the
same space,” said Nicole Vivalda, product manager at CornellCookson.
“And, from a training perspective, it allows students and residents
the opportunity to see both types of treatments for patients
coming into the hospital, as well as facility enhancements that can
keep people safe during behavioral health emergencies.”
The systems also offer the added safety benefit of a closure apparatus
mounted on the wall outside of the patient room. “By placing the
control panel outside of the room, staff are able to operate the door
without being in the space,” Vivalda said. “This provides the best level
of security for both the patient and the provider.”
Though safety and security are always top of mind, the lean budgets
on which many emergency departments and emergency medicine
training facilities operate mean large-scale construction projects and
the facility downtime associated with them are simply not possible.
The technology behind the engineering of ligature-resistant counter
doors extends to installation as well. Many products are designed
with the flexibility to be easily retrofitted into existing spaces without
the need for extensive or time-consuming renovations.
Many doors are affixed with sturdy and simple-to-install structural
tubes, which means they don’t require the backing of studs or a support
wall. The tubes can simply be put into place and drywall can be
built around the door guides for a fast, seamless installation while
emergency departments remain in operation. This also helps with
existing space constraints in most emergency department rooms as
doors can be added with a very narrow footprint.
Managing behavioral health risks in emergency departments and
emergency medicine training facilities is tricky. Beyond the dangers
to patients and staff, untrained staff and ill-equipped emergency
rooms can also leave medical facilities open to potential liability risks.
Adequate training for doctors, nurses, residents and med students
is part of the equation. But implementing measures like anti-ligature
rolling doors offer an added safety measure that creates more secure
“These products are an easy solution to a very serious problem,”
Vivalda said. “They can prevent hospitals from having to build a separate
wing for mental and behavioral health patients. Exam rooms
can be easily transitioned back and forth with the touch of a button.
It doesn’t get much easier than that.”
Securing for Future Care
Because many emergency departments and emergency medical
training facilities are not built for the special requirements involved
in behavioral healthcare, there is a lack of resources for treating
patients in a safe and secure environment.
Facility managers can turn to door manufacturers to help with
creative new ways to turn emergency care rooms into behavioral
health-friendly spaces. This can also save healthcare providers money
and resources while providing needed security for doctors, nurses,
residents and patients.
This article originally appeared in the May / June 2021 issue of Campus Security & Life Safety.