Emergency Room (ER) Care

​​​Emergency Rooms (ERs) provide a full range of medical interventions for those experiencing health emergencies. Generally, they do not specialize in behavioral health treatment or interventions. Some ERs have behavioral health crisis teams that evaluate, treat and disposition those with behavioral health crises. Some ERs also have access to onsite or video (tele) psychiatry.

Intended Population

  • ERs are intended to serve members' emergent needs that cannot be addressed in the community or in other less restrictive settings. Generally, ERs care for those experiencing life-threatening emergencies, for who safety cannot be maintained without this intervention. ERs are a crisis resource of last resort, except in cases where members require medical stabilization to correct a physical malady (i.e., after a self-harm event) or when a member's behaviors are so dangerous that physical and/or chemical restraint are necessary to protect his or her safety or the safety of the public.

Recommended Best Practices

Expected Outcomes

  • Core Expected Outcomes

  • Prompt placement in an appropriate crisis facility

  • Appropriate linkage to outpatient/community-based resources for those being discharged home

  • Low readmission rates to emergency levels of care

Management Approach

  • Cardinal Innovations does not manage ER visits through prior-authorization for services. Services are reviewed retrospectively only.

  • Cardinal Innovations retrospectively identifies those members with high crisis system usage and targets interventions through care coordination with those members. Select ERs also have dedicated inpatient liaisons to assist with care coordination and linkage.

  • Cardinal Innovations recognizes the difficulty in finding appropriate inpatient level facility beds, especially for adult members with severe illnesses and those with significant comorbidies (medical, intellectual disabilities, substance use disorders) and is working with the state to address this issue.