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Mission 0 and New Hampshire Hospital: state says ED boarding has fallen; hospital outlines ongoing discharge bottlenecks
Summary
DHHS officials and New Hampshire Hospital leaders reported progress on Mission 0 to reduce emergency-department (ED) boarding of behavioral-health patients, but hospital officials said a subset of inpatients remain in facility beds longer than clinically necessary because of shortages in lower-level community placements.
Department leaders described Mission 0 as a targeted, multi-partner effort to reduce ED boarding for behavioral-health patients. "We created Mission 0 which basically was a concerted effort to reduce that number," Commissioner Lori Weaver said, adding the initiative focuses on both front-door processes and on whether patients leaving care have stable placements.
Ian Watt, director of the Division of Public Health Services, and other DHHS speakers described coordination with hospitals and community providers to reduce ED wait times. Watt noted the department’s public health teams and partner organizations are involved in surveillance, prevention and community linkage activities that support Mission 0 work.
Ellen Lapointe, chief executive officer of New Hampshire Hospital, said the hospital and other partners have used a centralized intake system, Care Traffic Control (CTC), to manage involuntary emergency-admission referrals and centralize admissions. "In the past year, we've been an integral part of Mission 0… I am proud to say that on 4 occasions recently, we have achieved a queue of 0 adults waiting in the state," Lapointe said.
Lapointe acknowledged that persistent “back-door” delays remain: a number of inpatients at New Hampshire Hospital are clinically ready for discharge but cannot move to lower-level community settings because of limited capacity outside the hospital. She said the hospital has opened to full bed capacity (185 beds, up from about 142 a year earlier) but that a share of patients remain hospitalized for weeks or months while appropriate community resources are secured.
Lapointe and DHHS officials described a January work group to address discharge delays, convening the hospital, community mental-health centers, the Division of Behavioral Health and other stakeholders to identify resource gaps and process changes to speed discharge when clinically appropriate.
The committee received no votes or formal actions on Mission 0 at the orientation. Hospital and department leaders said the work requires continuing coordination across agencies and providers to align bed capacity, mobile crisis and community supports.
