23-hour crisis observation units aim to quickly assess needs, initiate treatment, and plan for discharge to ensure ongoing stabilization in the least restrictive setting. An interdisciplinary team uses various interventions—such as medications, peer support, family involvement, and care coordination—to address crises and resolve psychosocial barriers. 

This unit is an active treatment center designed for quick intervention to resolve crises swiftly, with a "door-to-doctor" time of under two hours. An interdisciplinary team, including psychiatrists, nurse practitioners, and physician associates work around the clock to provide care and treatment. The team employs a range of interventions—from medications and peer support to family involvement and care coordination—to tackle crises and overcome psychosocial barriers. 

Population served 

Individuals who need 23-hour crisis care often have serious medical issues. They might be a danger to themselves or others, unable to take care of themselves, or need constant monitoring for things like intoxication or withdrawal. Instead of waiting in the emergency department (ED) for a psychiatric bed, many come directly from first responders, sometimes without prior stabilization. There are no restrictions based on the severity of their condition, and law enforcement must accept them. 

These units care for both voluntary and involuntary individuals, aiming to encourage voluntary treatment when possible. Care is based on medical needs, not legal status, and a person's legal status can change during treatment. Many involuntary individuals may become voluntary while in the unit. Excluding individuals based on legal status could deny those needing specialized care from accessing less restrictive, voluntary treatment options, which is crucial compared to waiting in the ED. 

The team behind 23-hour crisis care 

The 23-hour crisis unit team includes behavioral health specialists, social services staff, nurses, and peers who have lived through similar experiences. The specialists keep people safe and help with daily tasks. Behavioral health specialists manage the milieu, ensure safety, and assist patients with activities of daily living. Social services staff conduct assessments, talk to families, provide counseling, and coordinate care. Nurses can administer medication for psychiatric conditions, withdrawal management, chronic medical issues, and acute agitation under physician supervision. Peers leverage their personal experiences to build connections with patients, assist with housing and food needs, and guide them through the healthcare system.

The goal of the 23-hour unit is to quickly figure out what the person needs, start helping right away, and plan for them to keep getting better in the best place for them after they leave. The team works together to get the person through the crisis. They might use medicine, support groups, time with family, and help individuals find resources. They don't decide what to do next until they see how the person is doing after some help. After some treatment, a lot of people get better and can go home or go to a less intense program instead of the hospital. 

It's key to know (especially when these units are attached to emergency departments) that 23-hour crisis units are not just places to hold people until a hospital bed is available. This is real help that starts with the idea that every crisis can get better. They try to get people to see a doctor in under two hours, so help begins right away. A psychiatrist or other doctor is there 24/7 to see patients often and start treatment quickly. Nurses give medicine to help with conditions like withdrawal, chronic illness, and minor medical issues. They can also quickly give medicine to calm someone down if they get agitated, with a doctor's supervision. 

Center features and capabilities 

23-hour observation units are designed with an open, therapeutic layout that enables continuous monitoring and flexibility to manage fluctuations in patient volume. These units feature dedicated entrances for first responders, adhere to ligature safety standards, and offer secure accommodations. They also utilize automated dispensing systems for efficient medication administration and are equipped to manage seclusion and restraint if necessary. 

The 23-hour crisis observation unit plays a critical role in effective crisis management by providing prompt, comprehensive care and stabilizing individuals in a supportive and controlled environment. Through its dedicated and interdisciplinary approach, it not only addresses immediate needs but also plans for a smooth transition to ongoing care or discharge. 

SOURCE: https://www.sciencedirect.com/science/article/pii/S0193953X24000443