Psychiatric Urgent Care Center
University Physicians Hospital at Kino
Behavioral Health Emergency and Inpatient Services
In 2004, University Physicians Healthcare (UPH) and Pima County Government initiated a 25-year contract for UPH to assume operations of the county-owned hospital on the Kino Healthcare Campus. This contract serves as a foundation to reestablish comprehensive medical services for residents of Southern Pima County, expand regional health-professional training programs in association with the University of Arizona and other educational institutions, and as a source of new jobs and other economic opportunities in the area.
Since formally assuming responsibility for the hospital in June 2004 UPH has achieved several patient care milestones:
In addition, UPH and Pima County have worked together to improve regional health care resources:
A major part of the UPH / Pima County relationship is the provision of inpatient psychiatric services for individuals entering the mandatory evaluation process associated with the Title 36 State Statutes. The Court Ordered Evaluation process addresses individuals in personal crisis and/or presenting a risk to community safety. Most of these patients are considered severe and acutely mentally ill. The legal process determines if these individuals require comprehensive behavioral health evaluation (often requiring several days stay in an appropriate behavioral health inpatient program). UPH currently provides care to approximately 64 psychiatric patients at all times, most (75%) involved in the Title 36 process.
In May 2004, Pima County voters approved a $12 MM request for partial replacement of existing psychiatric facilities using Pima County General Obligation Bonds. This request only partially covers the expense of fully replacing the existing facilities with a facility designed to promote care and treatment of this special group of patients, and advance the understanding of these disorders.
The current complement of 64 psychiatric beds is located in two facilities on the Kino Campus. There is a freestanding 36-bed unit located on the northwest side of the hospital. The remaining 28 beds are located in a space originally designed as medical surgical units on the fifth floor of the main hospital. All of the hospital facilities were constructed in 1977. They were not originally designed and cannot be adequately retrofitted to address the complex safety, security and quality of care concerns associated with this severe and acutely mentally ill population.
Patients in behavioral health crisis are routinely brought to our Emergency Department by law enforcement, other community agencies or family members. Every day there are an average of 12 crisis patients admitted to our emergency department requiring an average of eight hours of highly supervised emergency medicine care. The patient may have medical and psychiatric evaluations or require up to 24 hours of detoxification services (due to drug or alcohol abuse), requiring ongoing medical and psychiatric supervision and evaluation. During this time, many community agencies and programs are mobilized to assess whether there are resources to appropriately care for these individuals upon discharge. The more severely ill patients are brought through an assessment for hospital admission, or the possibility of the Court Ordered Admission process.
The growth of our behavioral health patient base is reflected in our annualized Emergency Department utilization statistics:
Behavioral Annual Rate Percent With
2004 3,042 45%
2005 3,483 15% 53%
2006 (estimate) 4,200 21% 58%
The Emergency Department is concurrently caring for many other patients with acute medical conditions. Like all emergency departments in the region, the UPH department has quickly increased in volume to operate at maximum capacity. It is a busy, noisy, stressful environment as large numbers of emergencies and urgent care patients present throughout the day and night. The co-location of patients with behavioral problems and those with medical problems adds to the unwieldy nature of the care environment and is disruptive to the flow of patients. Ideally there would be adequate space to effectively separate behavioral and medical emergency patients. Agitated behavioral patients need a quiet, non-stimulating environment that is not currently available. Separation of behavioral and medical emergency patients will create a more effective care environment for both groups of patients.
The current behavioral health inpatient units present significant limitations in our ability to provide care and efficiently work toward the appropriate discharge of our patients to community-based programs. There are serious security risks associated with the movement of patients from the emergency department where most are admitted, to the inpatient units and to the “Title 36” courtroom. Most of the facilities were originally designed for acute medical services, and cannot be retrofitted to address the elevated security and safety risks involved with caring for these patients. For example, there is no safe means to chaperone patients to an outdoor environment from the fifth floor units.
Inpatient units are poorly designed for this severely and acutely mentally ill population. This represents a serious compromise of both the quality of care and the safety of patients and health workers. For example, remodeled spaces in the main hospital (originally designed for inpatient medical services) represent a high risk to the safety of patients and mental health workers. There are alcoves and other areas where visual supervision of patients is not possible because of obstructed views. As a result patients cannot be seen and cannot be adequately supervised from even a few feet away. Another design problem is the limited support space in the patient care areas. Day room activities, group therapy, individual evaluations and counseling, medication management and visitor activities are all compromised by the lack of adequate space. Throughout the organization we lack sufficient space to insure that our patient’s rights to confidentiality are fully protected. There is also a risk of harm to patients trying to elope because of inadequate facilities design characteristics.
Stretching valuable health care and behavioral health dollars is a goal of our program. Since becoming responsible for these services UPH has reduced the length of inpatient stays by 28% and likewise reduced its costs to the healthcare payers. This falls within our mandate, since the majority of behavioral health patients are now referred to appropriate outpatient treatment programs on a more efficient basis. Creation of better patient care spaces will further improve our ability to assess patient’s needs and requirements to return to the community.
The Pima County Superior Court conducts legal proceedings associated with the Title 36 process in the hospital. Staff and attorneys representing the County Attorney’s office are housed in patient rooms on the hospital’s fourth floor medical units. The court and associated offices are located in the hospitals third floor. With the limited space available for medical patients, the County Attorney’s staff must be located to other areas in order to expand essential medical services. The courtroom environment on the third floor is equally misplaced. It is located in the core area of one of the hospital’s public areas. There is inadequate security for the protection of patients, hospital visitors and employees. The coming and going of the individuals involved in the court process also represents an infectious disease threat to medically compromised patients and allows access to the hospital for individuals who could compromise the safety and effective operation of the medical services.
UPH is requesting taxpayers consider providing additional funds through General Obligation Bonds to construct an 80-bed freestanding psychiatric unit and associated Institute for Psychiatry and Clinical Neurological Sciences. This new facility will incorporate current and anticipated design concepts to improve the quality and efficiency of behavioral health patient care, addressing security and safety concerns. The Title 36 Court and attorney group should also be located within the facility adjacent to the behavioral health units. Incorporating the $12 million approved in the 2004 Bond Referendum, our planning team anticipates the need for an additional $48 million to complete this project.
The Institute for Psychiatry and Clinical Neurological Sciences is a University of Arizona initiative, rooted in the breakthrough discoveries at the frontiers of human neurological and psychiatric clinical research. This approach involves an expansion of UPH clinical facilities and capabilities at the Kino Campus. Clinical research in neuro-psychiatric disease will form a core element of our expansion at the Kino site. Translational neuroscience research capacities (basic science) will remain on the main U of A Campus occupying part of the new Medical Research Building.
The facility would be sited on the south side of the existing hospital, separating these services in a defined area, accessible to our patients, their family and associates, community caregivers and related academic community.