Date of Publication


Project Team

Brenda Hamel-Bissell E d. D. RN and Paul Capcara MPH, RN


Purpose: This project’s aim was to reduce the length of emergency department (ED) stays for psychiatric boarder patients at Central Vermont Medical Center (CVMC) and prevent unnecessary psychiatric inpatient admissions through access to psychiatric crisis stabilization care.

Methods: June of 2016, CVMC ED developed a unit called the Transitional Care Area (TCA). TCA staffing consisted of mental health workers and security staff. Training strategies were derived from national evidence-based psychiatric care emergency programs (i.e., Alameda Model), along with pertinent safety actions from The Joint Commission. Training modules focused on community social supports, behavioral crisis stabilization modalities, and development of crisis stabilization treatment plans. TCA committee was developed to promote awareness and willingness for change on TCA unit and address key issues while transitioning the TCA towards a clinical crisis stabilization treatment approach.

Results: Periods of 8/1/2016-9/30/2016, and 8/1/2017-9/30/2017, respectfully 147 and 82 patients were admitted to the TCA. Out of these admissions, 44 (2016 period) and 39 (2017 period) patients were referred for intensive psychiatric treatment. The average length of stay (LOS) for these patients was 52.9 hours (2016 period) and 69.9 hours (2017 period). Questionnaire responses identified the need for expansion of the TCA to offer a more therapeutic environment (i.e., fresh air, windows, and therapeutic furniture and electronic technical supports (i.e., Reconnect Media Wall), increased the need for staffing including Peers, and expansion of nurses and APRN role in the TCA.

Conclusions: TCA Committee was successful in promoting change and access of increase staffing resources and security were no longer considered direct patient care staff. This project suggests that crisis psychiatric stabilization care with adequate staffing, could be cost-effective, decrease psychiatric ED boarder’s LOS and need for inpatient care. The project also displays the potential of replication in other ED’s in Vermont

Document Type


Included in

Nursing Commons