How MUSC Increased EmPATH Unit Utilization From 12% to 40%
Medical University of South Carolina leaders improved EmPATH utilization by changing patient-flow defaults, expanding overnight psychiatric coverage, refining admission criteria and building staff confidence in the model.
Original reporting by Ella Ruder, Becker’s Behavioral Health • July 15, 2026
How did MUSC improve EmPATH utilization?
MUSC increased adult EmPATH unit utilization from roughly 12% to nearly 40% by making EmPATH the default destination for eligible psychiatric emergency patients, using its traditional holding area only as backup, extending clinical coverage overnight, loosening overly restrictive selection criteria and bringing in outside operational expertise.
MUSC Health opened its eight-bay adult Emergency Psychiatric Assessment, Treatment and Healing unit in Charleston in July 2025. During its first six months, the unit operated at approximately 12% daily utilization. By July 2026, utilization had climbed to nearly 40% as leaders redesigned workflows and encouraged emergency department teams to use the therapeutic psychiatric setting more consistently.
MUSC’s EmPATH utilization results at a glance
24–28 → ~4 hrs
Reduction in waiting time for patients needing an inpatient bed.
552 patients
Adults served from opening in July 2025 through March 2026.
12% → 40%
Increase in daily EmPATH unit utilization.
20–22 → 12–13 hrs
Reduction in average psychiatric ED length of stay.
Why the EmPATH unit was initially underused
Before EmPATH opened, clinicians commonly placed psychiatric emergency patients in a traditional holding area known as the D-pod. That established habit continued after the new unit launched. Teams also applied narrow inclusion and exclusion criteria, effectively waiting for an “ideal” EmPATH patient instead of transferring patients for assessment and then determining the most appropriate level of care.
This combination of ingrained workflow, staff uncertainty and conservative eligibility decisions limited early utilization.
1. Make EmPATH the default psychiatric care setting
Beginning July 1, 2026, MUSC reversed its original workflow. The EmPATH unit became the primary destination for psychiatric patients arriving through the emergency department, while the D-pod became a backup area for patients requiring seclusion or a higher level of containment.
The change also allowed MUSC to return six of the D-pod’s 12 bays to the medical emergency department, supporting broader capacity and throughput.
2. Broaden patient eligibility
MUSC leaders moved away from overly restrictive screening criteria. The revised approach was to place appropriate psychiatric patients in EmPATH, complete the assessment there and move only those who truly required the D-pod.
The system has also considered admitting selected intoxicated patients and patients experiencing substance withdrawal when they do not have significant medical instability. This could allow patients to stabilize in a calmer psychiatric setting rather than board in the medical ED.
3. Expand overnight psychiatric coverage
Under the previous staffing model, a psychiatrist and advanced practice provider were available from 7 a.m. to 11 p.m. Patients arriving immediately after coverage ended could wait seven or eight hours before receiving a psychiatric evaluation.
MUSC extended advanced practice provider coverage until 3 a.m., added overnight psychiatrist availability by phone and assigned on-call residents from 3 a.m. to 7 a.m. The result was continuous psychiatric coverage for the EmPATH unit.
4. Use peer education and outside expertise
Clinicians who were comfortable with the EmPATH model helped educate colleagues and normalize the new workflow. MUSC also invited Scott Zeller, MD, and the EmPATH Consulting team to review operations and identify practical improvements.
This combination of internal champions and external assessment helped the health system identify operational changes while building confidence among frontline teams.
How EmPATH affected psychiatric emergency department length of stay
Before the adult EmPATH unit opened, patients presenting with behavioral health concerns spent an average of 20 to 22 hours in MUSC’s emergency department. After implementation, average length of stay fell to approximately 12 to 13 hours.
MUSC’s stated goal is to reduce that figure further to eight or nine hours. Leaders noted that statewide shortages of inpatient psychiatric beds may make it difficult to match the two- to four-hour stay common for medical emergency patients.
EmPATH also shortened inpatient psychiatric bed waits
Patients who required inpatient psychiatric admission previously waited an average of 24 to 28 hours in the emergency department. As more patients moved through EmPATH and fewer required hospitalization, the average inpatient bed wait fell to about four hours.
MUSC also established an inpatient discharge-identification target of 11 a.m., with a buffer to 1 p.m., to free beds earlier for patients awaiting admission.
Pediatric use of the adult EmPATH environment
MUSC does not have a separate psychiatric emergency space for children at this location. Pediatric patients are evaluated in the medical ED and may move into the EmPATH unit after medical clearance.
Some pediatric patients waiting for inpatient beds have improved enough in the therapeutic environment to return home instead of being hospitalized. MUSC characterized this observation as preliminary rather than a formal outcome finding.
Reimbursement and financial sustainability
MUSC receives hourly Medicaid reimbursement during a patient’s first 24 hours in EmPATH, when the service is treated as an observation stay. The system then receives a daily payment of approximately $400 after the first day.
Hospital leaders reported early signs that the model may reduce losses associated with uncompensated psychiatric boarding. However, they cautioned that reimbursement data remained preliminary because Medicaid payments can take several months to process.
Lessons for health systems implementing an EmPATH unit
- Change the default workflow: A new care environment will remain underused when legacy pathways stay easier or more familiar.
- Avoid searching for the perfect patient: Assessment inside EmPATH can help determine who needs a more restrictive setting.
- Cover nights and early mornings: Gaps in psychiatric staffing can erase gains made during daytime hours.
- Develop frontline champions: Peer education can help shift culture and reinforce appropriate utilization.
- Track operational and financial outcomes: Utilization, length of stay, admission waits, discharge rates and reimbursement should be evaluated together.
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