The Emergency Department & Upstream Playbook

Resources and support for hospitals and health systems looking to standardize care and improve experiences in the emergency department for patients with behavioral health and substance use issues.

Why It’s Needed
About 12.5% of emergency department visits are related to a primary behavioral health concern. Without a standard of care in place to efficiently treat individuals, patients often wait in the emergency department for long periods waiting to be transferred. Often hospitals do not coordinate or manage care for patients, and there are few alternatives to going to the emergency department to prevent and address crises.


  • Improve health outcomes and care experience for patients with behavioral health concerns.
  • Increase employee satisfaction.
  • Reduce the frequency and length of emergency department stays.

Guiding Principles

  • The playbook incorporates best practices and recommendations from the IHI ED & UP Learning Community and the ED & UP Getting Started Guide, as well as lessons learned from Providence hospitals.
  • Objective and goals are aligned throughout the Providence family of organizations or other organizations and health systems. At the same time, each ministry or hospital has its own unique mission and culture.
  • Providence takes a systematic approach to the implementation process. At the same time, each ministry will adapt and adjust to meet the specific needs of their patients and staff.

Selected Resources
Dive directly into the playbook for specific guidance on the following areas:

Download Playbook icon_download Created by Alice Noirfrom the Noun Project