New Butler center to ease wait for care

BUTLER HOSPITAL employees who are members of SEIU District 1199 New England voted, 282 to 2, to approve a new collective bargaining agreement with Butler, a Care New England facility, on April 11. Pictured is Butler Hospital's Riverview Building. / COURTESY BUTLER HOSPITAL
BUTLER HOSPITAL employees who are members of SEIU District 1199 New England voted, 282 to 2, to approve a new collective bargaining agreement with Butler, a Care New England facility, on April 11. Pictured is Butler Hospital's Riverview Building. / COURTESY BUTLER HOSPITAL

There used to be a courtyard adjacent to the admitting area of Providence’s Butler Hospital, where patients could have a smoke while they waited to be seen. Now that space has a roof overhead, the only sign it ever saw sunlight two tiles in the ceiling decorated to look like blue sky with white clouds.
The old courtyard now serves as an additional waiting room – it is currently the only way the nonprofit hospital can separate its patients while they wait. Otherwise, old and young, acutely ill or stable, wait together in the same room. On a good day, the wait is three hours; on a busy day, five.
The wait is so long because 40 or more patients come in every day. Butler has been consistently overcapacity in the past few years. In 2009, the hospital was granted a variance from the Department of Health to fill an additional 20 beds over its 117 licensed-bed capacity.
But this month, Butler opens an expanded patient-care center in the new $16 million Riverview Building that will enable the hospital to treat the increasing number of patients needing psychiatric and substance-abuse services. A new intensive-treatment unit, which opened Oct. 1, will be able to treat 26 more patients, growing the hospital’s capacity to 143 beds.
The new patient rooms offer more privacy than those on the general unit. In addition, the space includes soothing, low-stimulation areas where patients who may be highly agitated can find quiet, listen to music or even exercise, said Dr. Martin Furman, the unit’s chief.
The expanded services are expected to alleviate some of the pressure on other hospitals whose waiting rooms are often backed up with patients seeking behavioral-health treatment. Dr. Brian Zink, chief of emergency medicine at The Miriam Hospital and Rhode Island Hospital, which sees 15-18 patients seeking behavioral health services each day, said there currently aren’t enough state beds for the uninsured or Medicaid patients.
In the coming year, Rhode Island Hospital will also be expanding its number of psychiatric beds to meet increasing demands, he said.
But why is there an increasing demand for inpatient mental-health services in the first place? It depends on whom you ask.
Rhode Island has the highest incidence of mental illness in the country – with one in every four adults experiencing some type of mental illness compared to the national average of one in five adults, said Craig Stenning, director of the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. The state’s utilization rate, or the per capita rate for receiving services, is also slightly higher than the country’s average, he said. Providers and health care administrators alike seem to agree that the economic recession is a major factor –people lose their jobs, then their homes, and they often become depressed. Over the past several years, Butler has seen an increased number of patients who can’t pay for care – in 2009, it logged $3.2 million in uncompensated care, just two years later that figure doubled.
Another factor is increased awareness of the symptoms of mental illnesses and where to go for help, along with an amelioration of the stigma on mental illness. Stenning cited the Rally4Recovery as evidence of progress – 11 years ago when the rally started, only 100 people came. This year nearly 13,000 people attended, he said.
The hospital doctors also point to overburdened outpatient services. In some cases, patients are admitted to the hospital because a “tight outpatient plan,” which might be preferable, is not an option, Zink said. After patients are discharged, it can be weeks before they see a psychiatrist, said James Sullivan, deputy medical director for clinical services and assistant unit chief of the Kent Unit at Butler Hospital, during which time they are at risk of returning to the hospital for readmission. One of the problems may be that the Medicaid reimbursement rate for outpatient services has been poor, Zink said, but modifications under the Affordable Care Act will allow for expanded outpatient services.
Dale Klatzker, president and CEO of The Providence Center, acknowledges that community health centers don’t have the resources to hire as many psychiatrists as they might like, but he sees lack of coordinated care as the main problem. Community-based and hospital-based behavioral-health services are “siloed” off from one another, he said, so that neither is fully aware of the array of available services. The disconnection makes whatever resources each has less effective and efficient, he said.
But efforts are being made to integrate the two arms: Butler and The Providence Center signed an affiliation this past spring and Lifespan and Gateway Healthcare merged soon after. “We are treating the same people,” Klatzker said. “We need to work together to treat the same people, so we don’t waste dollars and point fingers and we mobilize around the best interests of the client.”
All stakeholders agreed that in lieu of other choices, providing patients with inpatient care is the right thing to do.
Butler’s new center also includes an expanded patient-assessment services admissions area, opening Oct. 20, that is double the current area’s size, providing more comfort to patients and cutting wait times.
Previously when a bed opened up, it was given to the first patient who needed it – regardless of whether that was the appropriate level of care. And beds weren’t turned over as quickly as they could have been – often there was a delay in communication between the unit staff, housekeeping and admitting.
Now the hospital will be better able to place patients on units that are the right level of care for them. Patients will be tracked in real-time using a new tele-tracking system, so that as soon as a patient has been discharged and their bed cleaned (housekeeping will be alerted via text message that rooms need to be cleaned), a new patient can be admitted. A two-week testing period of the new system showed that the turn-around time for cleaning rooms dropped from 40 minutes to 26 minutes.
If no beds are available at the end of the day, but patients are waiting in the admitting area, they will now be able to stay overnight. Five evaluation rooms have chairs that fold out into beds.
The new facility has both a locked and an ambulatory waiting area – so that patients who might require an outpatient level of care can stroll Butler’s beautiful campus or sip coffee in the cafe while they wait. These patients will be given a pager to notify them when the hospital is ready to see them.
“We actually designed the space around the process,” said Dr. Susan Szulewski, unit chief of patient-assessment services. The majority of patients used to be transfers from the emergency rooms of other hospitals or were referrals from community mental-health centers, she explained. But now 60 percent of patients are walk-ins – up from 20 percent five years ago.
Stenning said Butler’s new facility is a “good step forward” in improving access to care, which he hopes will continue to improve with the Affordable Care Act, as more people will soon have health insurance. •

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