CALM Interventions: Behavioral Health Crisis Assessment, Linkage, and Management Improve Patient Care

Am J Med Qual. 2018 Jan/Feb;33(1):65-71. doi: 10.1177/1062860617696154. Epub 2017 Mar 1.


Emergency departments (EDs) have seen rising numbers of patients in psychiatric crises, patient boarding, and throughput delays. This study describes and evaluates the impact of a Crisis Assessment Linkage and Management (CALM) service designed to manage behavioral health crises. A year-to-year comparison was performed before (n = 2211 ED visits) and after implementation of CALM (n = 2387). CALM was associated with reductions in median ED and hospital length of stay (LOS) from 9.5 to 7.3 hours and 46.2 to 31.4 hours, respectively. Mean transformed ED LOS decreased by 32.4% ( P < .001). The CALM model improved patient care and throughput metrics by proactively managing behavioral health crises.

Keywords: ED operational efficiency; emergency department; models of emergency psychiatric care; psychiatric care.

MeSH terms

  • Academic Medical Centers / organization & administration
  • Adolescent
  • Adult
  • Crisis Intervention / organization & administration*
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Mental Disorders / therapy*
  • Middle Aged
  • Racial Groups
  • Retrospective Studies
  • Time Factors
  • Young Adult