Welcome to Kaiser Permanente South Sacramento Emergency Psychiatry Fellowship!

Changing the paradigm of emergency psychiatry

Overview:

The Kaiser Permanente Emergency Psychiatry Fellowship is a one year program created to develop experts in the assessment and treatment of acutely psychiatrically ill patients, who are also interested in learning effective leadership skills and program development. Eligible candidates are graduates of either an emergency medicine or psychiatry residency program. The goal of the fellowship is to produce leaders in the field who can change the face of Emergency Department Psychiatry nationally. The year-long comprehensive clinical and didactic program is comprised of a well-rounded series of rotations and seminars to provide knowledge with a systems based approach.

Kaiser Permanente has an established reputation for delivering the highest quality clinical care and leading the nation in innovative ideas and strategies for healthcare. Kaiser South Sacramento is a melded academic and community hospital model. The ED currently serves a mixed socioeconomic population in South Sacramento and is the busiest ED in the area with an annual volume of 100,000. The ED is nationally recognized for expertise in ED flow and is a training site for Emergency Medicine residents from UC Davis.

The fellows trained each year will become excellent clinicians able to integrate biological, psychological, and social models in the treatment of their patients.

Background

In 2007, 12 million emergency department visits involved a behavioral health and/or substance abuse condition. This is one out of every eight ED visits. These visits were two and a half times more likely to result in hospital admissions. With the national shortage of available inpatient treatment beds, these patients are boarded in the ED’s. Traditionally minimal treatment has been given to patients who are often housed in ED’s for 24 hours and sometimes much longer waiting for an inpatient bed. Currently the Sacramento region is experiencing a crisis in emergency psychiatric care that is similar to the conditions found throughout large cities in the US. The need for a higher level of expertise in care of these patients could not be greater.

New Model

We have found that a new model for treatment of patients within the ED can provide greatly improved patient care while improving ED flow dramatically. Appropriate clinical diagnosis and treatment within the ED setting allows for an increased percentage of discharges from the ED, thus creating more inpatient beds, and a shorter length of stay in the ED.

The primary objective is to create experts in the assessment and treatment of psychiatric illnesses in the ED. The core curriculum is comprised of 12 months of Emergency Psychiatry where the fellow will be directly involved in patient care. The fellow will also be involved in Program Development and Research in the field of Emergency Psychiatry.

Throughout the year there will be dedicated weekly didactic sessions consisting of lectures, journal club, workshops and grand rounds.

In addition to the core curriculum there will be clinical rotations that will connect the fellow with experts in their respective fields.

By the end of the year, the fellow will be well equipped to develop and lead programs in Emergency Psychiatry

Clinical Rotations:

Emergency Psychiatry
Director: Yener Balan, MD
Site: Kaiser South Sacramento Emergency Department
Duration: 12 months
Overview: This clinical rotation will be ongoing throughout the fellowship year with direct supervision of medical care and management of emergency psychiatry patients in the South Sacramento Medical Center emergency department.

Geriatrics/Dementia
Director: Deborah Francis, RN
Site: Kaiser South Sacramento Inpatient Hospital
Duration: 2 weeks
Overview: This rotation will give the fellow exposure to the care of the elderly and demented patient with a focus on medication management and the special needs of these patients, who are frequently cared for in the emergency setting

Toxicology
Director: Steve Offerman, MD
Site: Kaiser South Sacramento Toxicology Clinic, Emergency Department, Inpatient wards, ICU
Duration: 2 weeks
Overview: The fellow will rotate with the Kaiser Northern California Toxicology faculty and see patients in the clinic as well as on call to regional EDs. The focus will be on acute management and care of overdoses, drug interactions and side effects.

Inpatient Adult Psychiatry
Director: Jeff Friend, MD
Site: Sierra Vista Hospital
Duration: 1 week
Overview: This rotation will expose the fellow to the inpatient care of patients with psychiatric emergencies as well as long term psychiatric care. The fellow will work at the inpatient facility for the South Sacramento Medical Center

Inpatient Adolescent Psychiatry
Director: Jason Bynum, MD
Site: Sierra Vista Hospital
Duration: 1 week
Overview: This rotation will expose the fellow to the inpatient care of adolescent patients with psychiatric emergencies as well as long term psychiatric care. The fellow will work at the inpatient facility for the South Sacramento Medical Center

Pain Management
Director: Mike Bicocca, MD/Arlene Burton, MD
Site: Kaiser South Sacramento Pain Clinic
Duration: 1 week
Overview: Pain management is an essential skill for the expert care of acute psychiatric emergency patients. The specialty care and management of long term pain patients will be the focus of this rotation in the pain clinic.

Outpatient Adult Psychiatry
Director: Humberto Temporini, MD
Site: Kaiser South Sacramento Outpatient Clinic, PACU for ECT
Duration: 2 weeks
Overview: This rotation will expose the fellow to the clinic care and outpatient management of patients with psychiatric illness, including ECT.

Chemical Dependency Services
Director: Jennifer St. James, LCSW
Site: Kaiser South Sacramento Chemical Dependency / Recovery Program
Duration: 2 weeks
Overview: This rotation will expose the fellow to the clinic care and outpatient management of patients with dual diagnosis and substance use disorders.

Didactic Curriculum:

The core curriculum includes educational lectures on assessment and treatment of medically complex acutely ill patients, leadership skills, development of psychiatric emergency services and programs, and skills on connecting with community resources.

Journal Club:

Fellows will participate in monthly emergency department journal club which covers a wide variety of emergency medicine literature and they will be responsible for presenting one emergency psychiatry manuscript per month.

Grand Rounds:

Fellows will present two grand rounds lectures over the course of the year on emergency psychiatry topics to the core faculty of the emergency department.

Supervision and Mentoring

Regular supervision is a core element of this fellowship, supported by experienced faculty and administrative leaders.

During this rotation, the fellow will learn basic Business Strategies including Business Plan development. Lean Methodology and Queuing Theory basics will also be addressed. Finally, program development of a psychiatric program for ED’s (both individually and as a health system) will be discussed.

Kaiser Permanente South Sacramento
Emergency Department
Psychiatry Emergency Services
Toxicology Clinic
Inpatient Psychiatry
Geriatric Inpatient Medicine
Pain clinic
Outpatient Psychiatry / ECT
Chemical Dependency Services
Intensive Outpatient Treatment

Administrative Experience:
Direct involvement with Emergency Psychiatry administrative meetings
One year Project developed with the Hospital Operations Team

Kaiser Permanente is a vast hospital network that supports research throughout Northern California. The Division of Research in Oakland, CA is home to the Internal Review Board for Kaiser and funds internal research grants and supports clinical research that benefits Kaiser hospitals as well as the medical profession at large. Kaiser Permanente utilizes a computer charting system that makes data analysis of large numbers of patients possible. Kaiser South Sacramento serves a diverse community with a high volume of patients with mental health emergencies and is an excellent clinical environment for research. The hospital participates in a research mentorship program with Drexel University Medical School and each year at least one student will be available to work exclusively on a project developed during the fellowship year. They will be available to assist with data collection and analysis, writing the IRB and assisting with clinical data collection.

Over the course of the emergency psychiatry fellowship, each fellow will participate in a research project under the supervision and guidance of Tony Berger, MD MS, fellowship co-director and translational clinical researcher. The fellow’s research project can be either an original research study or the fellow can assist with an ongoing research project in the department, provided their contribution is meaningful and significant and approved by Dr. Berger. The fellowship directors are developing a psychiatry patient research database that can serve as the basis for future projects.

The research component of the fellowship will account for approximately 6 hours per week of the fellow’s time (15%) and will include writing a research proposal and participation in the IRB writing process. Throughout the fellowship, ongoing data management, basic statistics work and a write up of the project results will be undertaken in the anticipation that the research will lead to submission of an abstract. Studies worthy of publication will be written in manuscript form, finalized and submitted for publication to an appropriate journal.

Our program directors co-administrate and provide expert knowledge along all the angles the fellow will be trained in:

Karen Murrell, MD, MBA, FACEP – Emergency Physician, Assistant Physician in Chief: Hospital Operations, Psychiatry, Emergency Medicine and Inpatient Medicine

Tony Berger, MD, MS – Emergency Physician

Yener Balan, MD, FAPA – Psychiatrist, Medical Director, Hospital Operations – Psychiatry

Research Project Coordinator:
Tony Berger, MD, MS

Emergency Psychiatry Fellowship Core Faculty:

Richard Isaacs, MD – Physician in Chief, South Sacramento
Mike Bicocca, MD– Anesthesia (Pain Management)
Arlene Burton, MD– Psychiatry (Pain Management)
Jason Bynum, MD – Adolescent Psychiatry
Andrew Elms, MD – Emergency Physician
Deborah Francis, RN- Geriatric Clinical Nurse Specialist
Jeff Friend, MD – Adult Psychiatry
Chris Lentz, MFT – Psychiatry
Lev Libet, MD – Emergency Physician
Steve Offerman, MD – Toxicology
Jennifer St. James, LCSW – Chemical Dependency
Humberto Temporini, MD – Adult Psychiatry

Application Deadline: Rolling

Eligibility:
We look for forward thinking, flexible, motivated attendings with desire to excel into leadership and team building.

All fellows must be credentialed through Kaiser Permanente by the time of entry into the program.

US citizens and green card holders must have a valid California State license to practice medicine, as well as be board eligible or certified by the time of entry into the program.

Application Procedure:
Candidates who are already employed as attendings at a Kaiser Permanente location must be nominated by their Chief of Service.

All candidates should submit their application materials directly to the address listed below.

The materials will be evaluated by the Emergency Psychiatry Fellowship Co-Directors, and shortlisted candidates will be invited to an in-person interview. If the candidate is suitable for a Fellowship position, the application packet will be forwarded to the Kaiser Permanente Human Resources Department for review and assessment for employment.

Should a position be available, the qualified candidate will be awarded a letter of offer and undergo the credentialing process for Kaiser Permanente and the Fellowship.

Application materials:
Please submit the following:

International applicants:
In addition to the above 3 requirements, please submit the following:

  • Valid ECFMG certificate
  • Proof of Visa status or US citizenship

Selection Timeline
Applications are accepted on a rolling basis, interviews are scheduled for short listed candidates only, and offers are also made on a rolling basis.

Acceptance into the fellowship is conditional on employment at Kaiser Permanente.
An offer of Fellowship is not final until the fellow has been successfully credentialed by Kaiser Permanente.

Contact Information:

For more information contact:

Karen Murrell, MD – (916) 203-2408; email: karen.l.murrell@kp.org
Tony Berger, MD – (916) 539-3319; email: tony.l.berger@kp.org
Yener Balan, MD – (916) 879-5878; email: yener.a.balan@kp.org