Healthcare Design - September 2020 - 27

HCD 10

CLINICIAN

SCOTT ZELLER
Vice president of acute psychiatry, Vituity,
(Emeryville, Calif. )
WHO HE IS: Scott Zeller, MD, has dedicated his career to psychiatric medicine,
in practice and beyond. He's the vice president for acute psychiatry with the
physician partnership Vituity; assistant clinical professor of psychiatry at the
University of California, Riverside; and past president of the American Association for Emergency Psychiatry. He serves on the editorial board for Psychiatric
Times and has authored three textbooks and many articles on emergency psychiatry. He's also the clinician who developed a fresh approach to delivering
compassionate and dignified care to mental health patients within the emergency department (ED) setting with his Emergency Psychiatric Assessment
Treatment and Healing (EmPATH) unit concept.

MAIN STREET STUDIO (IOWA); LEAH ABBOTT (FRANCIS CAN)

HKS (NORTH TOWER); ALMOOSA SPECIALIST HOSPITAL (IVF CENTER)

YEAR IN REVIEW: Zeller's EmPATH units come in response to a decade that's
seen a surge in the number of patients presenting in EDs with mental health and
substance abuse issues and the realization that the at-times chaotic nature of an
ED isn't conducive to effective psychological care. Zeller's own operational approach, the "Six Goals of Emergency Psychiatric Care," is the basis for the unit
design and includes: exclude medical etiologies of symptoms, rapidly stabilize
the acute crisis, avoid coercion, treat in the least restrictive setting, form a therapeutic alliance, and formulate an appropriate disposition and aftercare plan.
To support these tactics, the EmPATH unit design calls for a patient-centered
space that's an open physical environment, with a homelike, large central room
called the "milieu" that promotes a sense of normalcy free of more traditional
elements like barriers between patients and staff and physical restraints. In
the past year, Zeller provided guidance for the newly opened EmPATH unit at
Franciscan Health in Lafayette, Ind., and has been involved in the design of 11
currently operating EmPATH unit projects and another six in the pipeline. He
works to guide healthcare systems through required billing codes, operational
planning and training, and design of the physical environment.
INDUSTRY IMPACT: Zeller's approach to EmPATH unit design is guided by the
idea that the physical environment has a great impact on a patient's reaction to
treatment, resulting in a correlating decrease in involuntary medication administration and physical and chemical restraints where EmPATH units have been
implemented. The physical environment includes ample space, options to sit in
a recliner in active therapy or fold it flat to rest, self-service stations for snacks
and linens, and, frequently, an outdoor healing garden. It's estimated that the
unit design results in a 75-80 percent decrease in behavioral and mental health
inpatient hospitalizations and reduced length of stay in the ED. This is inspiring
greater change, as well. The Facility Guidelines Institute (FGI) will soon release
new requirements for behavioral health crisis units based on Zeller's work in
its draft of the 2022 Guidelines for Design and Construction of Hospitals. In fact,
Zeller was the lead clinical voice in the FGI topic group dedicated to developing
the fundamental standards for all models of behavioral health units in EDs and
behavioral health crisis units. His work in this arena stands to alter the landscape
for mental health and substance abuse patients in an acute crisis.

EmPATH unit, University of Iowa Hospitals and Clinics

EmPATH unit, Franciscan Health

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Healthcare Design - September 2020

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