Southwest Texas Crisis Collaborative
Law Enforcement Navigation (LENav)

Before the start of this program, emergency departments in Bexar County saw more than 9,000 emergency detention patients each year. Many patients whose primary presenting condition is psychiatric become stranded at the emergency room for hours due to interfacility transfer laws; at this point “boarding” occurs. “Boarding” refers to the nation-wide issue of patients presenting at emergency department for psychiatric care and who end up staying far longer than the average patient because emergency departments are awaiting interfacility transfers and unable to provide treatment for their psychiatric needs. Research shows that emergency departments are not clinically conducive to psychiatric stabilization, and the patients decompensate further [ref] . Nearly half of emergency detention patients need only a medical screening before routing directly to a psychiatric facility. A field medical stabilization process for EMS was developed collaboratively with the San Antonio Fire/EMS Medical Director, the Local Mental Health Authority, and psychiatric facilities’ medical directors that enables law enforcement to take medically stable emergency detention patients directly to psychiatric facilities, a process that greatly expedites their mental health treatment.

The Law Enforcement Navigation project utilizes the Southwest Texas Regional Advisory Council’s (STRAC) MEDCOM Communications Center, which was already navigating over 500 trauma transfers monthly, as the central coordination point to navigate medically stable emergency detention patients that are in police custody to the most appropriate psychiatric facility to improve the care of the patient. If the field evaluation process determines that the patient needs emergency medical care, the patient will be routed to the most appropriate emergency department.

MEDCOM monitors both 9-1-1 law enforcement responses to psychiatric related calls and psychiatric facilities diversion status in real-time to anticipate and navigate patients, to ensure adequate load-balancing of the crisis system. Patients are tracked in real-time and data is provided for analysis and system enhancement.

Program Goals:
• Improve navigation of medically stable ED patients to psychiatric facilities where care can begin sooner. The current system of boarding these patients in emergency departments that are not optimally equipped to care for their psychiatric needs slows the patients’ care.
• Decrease law enforcement officer drop-off times so the officer returns to service more quickly.
• Develop and implement a shared measurement system that will track common outcomes and indicators across the initiative, use results to inform learning and continuous improvement, and to communicate improvements across the Collaborative.
• Ensure effective facilitation of all Workgroup and Steering Committee meetings, provide regular reports on group progress against goals and indicators.
• Oversee the development of a local set of strategies that will ultimately drive transformative change in the region.