Samaritan Medical Center Announces Expansion of Emergency Department Behavioral Health Secure Unit

Published on: September 21, 2023

Watertown, NY – Samaritan’s emergency department (ED) will undergo a construction project to expand and enhance the care of psychiatric patients within the secure behavioral health unit (BHU).  The expansion is needed as the average daily census of patients has been consistently exceeding physical space.  The project is set to cost $2.5 million dollars and construction has begun.

Looking to the past:
In 2010 when we opened our modern ED a five-bed BHU secure unit was sufficient to meet the average daily census. Two overflow rooms were identified near the secure BHU that could be used when needed.  This left 31 remaining medical beds in the ED for a total of 38 beds in the entire department.  The psychiatric patient numbers have continued to climb over the years and prior to the pandemic in 2020 the average daily census was approximately seven patients.

Present condition:
The average daily census of psychiatric patients in the past 12 months has grown to approximately eight patients, with a high of over 20 patients at one time. There has been an increase in pediatric patients needing care.  This number collectively exceeds our secure unit and overflow capacity, which forces these patients into medical beds within the emergency department. This has two immediate impacts – there are fewer beds to treat medical patients and more staff members are needed to watch psychiatric patients in these medical rooms because there are inherent equipment and safety risks in a traditional medical room. 

Coupled with an increase in patient census, these patients, especially children, are waiting longer in our ED when they need hospitalization.  The current physical space to help safely stabilize these patients is not adequate within the emergency department’s current behavioral health unit (BHU).

The increased number of adults and children in a mental health crisis can be attributed to many factors, but there is not one particular trend.  The pandemic is certainly a newer factor with more stress, anxiety, isolation and breaks in outpatient care.  

Future solutions:
Samaritan leaders contacted the Department of Health (DOH) with our physical constraints and then decided to seek emergency approval on a Certificate of Need (CON) that identified the space we need. The full approval process can take up to 12 months, but the state quickly approved it.

Construction is now underway to expand to a 12-bed secure unit to meet the needs of the community and the ED will have 29 medical beds.  To gain this space, the current coffee shop in the main lobby will move to a different space in the lobby, as well as moving physician office space and claiming hallway space in the lobby area.  This will happen in a phased approach to limit the impact to current operations.  The project is expected to be completed by the Summer of 2024.

The BHU expansion project is set to cost $2.5 million dollars.  This was not budgeted for in 2023 but has been deemed necessary as a matter of patient safety concerns and to mitigate extra staffing needs. Several revenue sources have been identified, and Samaritan continues to look for grant dollars to help offset the construction costs.  The Samaritan Foundation, Children’s Miracle Network of Northern New York, and Jefferson County have all committed funds totaling approximately $793,000. 

The Samarian Foundation committed half of the net proceeds from its recent Thousand Islands Golf Tournament in June to the project for a total of just over $60,000. In addition, the Foundation is going to dedicate proceeds from an event later this year, Festival of Trees, to the project as well.

The Children’s Miracle Network of Northern New York and its allocations committee designated $300,000 to the project because there is a direct pediatric care need to this expansion.

On April 4, 2023, the Jefferson County Board of Legislators approved a request from Jefferson County Community Services to provide $430,000 to Samaritan Medical Center for this expansion project.  The funds have been made available as a result of the New York State Attorney General’s successful litigation with several pharmaceutical companies.  The $430,000 is designated to assist with the physical expansion of the behavioral health unit, which has experienced dramatic increases in opiate-related visits.  The funding will also be used to begin the important service of providing lifesaving, medication assisted therapies to those who need medical assistance to begin their journey to recovery.  

Samaritan is also applying for an expansion to our adult inpatient mental health unit from 34 to 39 beds. This request has been submitted to the New York State Office of Mental Health (OMH) as they oversee the operations of this inpatient unit. This expansion is needed since we are consistently at full capacity in this unit, as 50% of the adults coming into the emergency department for a mental health crisis are admitted to Samaritan for stabilization and a treatment plan. This project will cost approximately one million dollars.

“Our region continues to battle the mental health crisis needs in this rural community,” states Tom Carman, president and chief executive officer of Samaritan.  “Although there are many community-based programs, the need for emergent care through our emergency department, and transferring from other local hospitals who do not have this level of care, consistently surpasses a safe space for us to care for these patients in the existing physical footprint. The need to expand this secure unit has a trickle-down impact that helps these patients, plus the overall wait times for medical patients. The funding will also be used to begin the important service of providing lifesaving, medication assisted therapies (MAT) to those who need medical assistance to begin their journey to recovery.”

Emergency Department Behavioral Health Numbers:

From January 2022 to June 2023, 946 children presented to our emergency department for a behavioral health crisis.  Samaritan does not have an inpatient pediatric mental health unit, and those children needing to be hospitalized must be transferred to a facility with capacity in New York State.

• 273 of these children were deemed in need of hospitalization and transferred to a higher level of care.
• Pediatric patients had an average length of stay of 30 hours in 2021 and 35 hours in 2022, with a peak of over 72.  This is caused by a shortage of pediatric beds across the region and state. Children are waiting longer in our BHU and the new space will be more child-centered.
• Over 550 of these children were already established in outpatient behavioral health services in the community.

From January 2022 to June 2023, 3,461 adults presented to Samaritan’s Emergency Department for a behavioral health crisis. 

• 1,746 of these patients were admitted to Samaritan’s inpatient mental health unit.
• 210 of these patients were transferred to another facility for psychiatric care.
• 1,388 of these patients were stabilized in the ED and discharged home to continue their care plans.
• Adult patients average length of stay went from 12 hours in 2021 to 22 hours in 2022 and peaked at over 36 hours.

Overall, Samaritan’s emergency department cared for 35,570 patients (medical and psychiatric) in 2022.

Renderings of the new 12-bed secure unit being constructed in Samaritan’s emergency department.