How MUSC Boosted EmPATH Utilization From 12% to 40%
Medical University of South Carolina leaders increased use of their adult EmPATH unit by changing patient-flow defaults, extending overnight psychiatric coverage, broadening eligibility and building staff confidence in the model.
Original reporting by Ella Ruder, Becker’s Behavioral Health • July 15, 2026
What changed EmPATH utilization from 12% to nearly 40%?
MUSC stopped treating EmPATH as an optional destination for an “ideal” patient. The health system made the unit the default setting for eligible psychiatric emergency patients, reserved its traditional holding area for people who need seclusion, expanded overnight coverage and used outside expertise to identify operational improvements.
MUSC opened its eight-bay adult EmPATH unit in Charleston in July 2025. During its first six months, daily utilization remained around 12% as clinicians continued defaulting to the emergency department’s traditional psychiatric holding space, known as the D-pod.
By July 2026, leaders had reversed the workflow, broadened their thinking about eligibility and expanded coverage. Utilization climbed close to 40%, while behavioral-health length of stay and waiting for inpatient placement fell substantially.
MUSC’s EmPATH transformation by the numbers
12% → ~40%
Adult EmPATH utilization after MUSC changed workflows and staffing.
20–22 → 12–13 hrs
Average ED length of stay for patients with behavioral-health complaints.
24–28 → ~4 hrs
Waiting time for behavioral-health patients who still required an inpatient bed.
552 patients
Served by the adult EmPATH unit from its July 2025 opening through March 2026.
The unit opened, but old habits remained
MUSC’s emergency department had long relied on the D-pod, a 12-bay psychiatric holding area with a seclusion room for patients who were agitated or violent. Even after EmPATH opened, clinicians continued using the familiar space as their default.
Leaders also created restrictive inclusion and exclusion criteria while searching for an ideal EmPATH patient. The combination left the new unit underused despite its eight available bays.
1. Make EmPATH the default destination
Beginning July 1, 2026, MUSC made EmPATH the primary destination for psychiatric patients in the emergency department. Clinicians would move patients into the therapeutic unit, assess them there and use the D-pod only when a patient needed a more restrictive setting or seclusion.
The system reinforced that change by returning six of the D-pod’s 12 bays to the medical emergency team.
2. Change culture through peer education
Changing the written workflow was only part of the work. Some clinicians were more comfortable with the EmPATH model than others, so staff members who understood the service helped educate colleagues and build confidence in the new pathway.
The experience shows why implementation depends on shared habits: a new physical unit will remain underused when clinicians continue following the legacy route.
3. Bring in outside operational expertise
MUSC invited Scott Zeller, MD, lead consultant for EmPATH Consulting, and his team to review operations before the July workflow change. Their feedback helped leaders identify practical improvements and reconsider criteria that limited access.
One recommendation was to allow appropriate intoxicated patients—or people withdrawing from drugs or alcohol—to stabilize in EmPATH when they did not have major withdrawal-related vital-sign changes.
4. Close the overnight coverage gap
Previously, a psychiatrist and advanced practice provider were available only from 7 a.m. to 11 p.m. Patients arriving just after coverage ended could wait seven or eight hours before psychiatric evaluation.
Under the new model, advanced practice providers cover until 3 a.m., a psychiatrist remains available by phone overnight and on-call residents cover from 3 a.m. to 7 a.m. Together, those changes provide around-the-clock clinical coverage.
Length of stay fell after EmPATH opened
Before the adult EmPATH unit, patients presenting with severe panic attacks, suicidal thoughts or other behavioral-health complaints spent an average of 20 to 22 hours in the MUSC emergency department. That figure dropped to roughly 12 to 13 hours.
MUSC’s goal is eight to nine hours. Leaders expect some remaining difference from medical visits because South Carolina continues to face a statewide shortage of inpatient psychiatric beds.
Patients awaiting inpatient care also moved faster
Patients who still needed inpatient psychiatric placement previously waited an average of 24 to 28 hours in the emergency department. With more patients receiving active treatment in EmPATH and fewer competing for a bed, the reported wait fell to around four hours.
MUSC also set an 11 a.m. discharge-identification target—with flexibility until 1 p.m.—to release inpatient capacity earlier in the day.
The unit is supporting pediatric patients, too
MUSC does not have a separate pediatric psychiatric space. Children receive psychiatric evaluation in the medical emergency department and can move into EmPATH after medical clearance, including while waiting for inpatient placement.
Leaders observed that some pediatric patients improved in the therapeutic setting over a day or two and returned home rather than being admitted, although MUSC emphasized that this observation was still anecdotal.
Reimbursement is improving—but sustainability is still being tested
South Carolina Medicaid pays an hourly observation rate for a patient’s first 24 hours in EmPATH, followed by a daily rate of about $400. That creates revenue for care that previously generated little payment while patients boarded in the emergency department.
MUSC is sharing two years of operational and financial data with Medicaid partners to determine whether the current rate supports long-term sustainability. Leaders cautioned that payment delays make it too early for final financial conclusions.
Implementation lessons from MUSC
- Change the default: Make EmPATH the expected pathway instead of an optional alternative.
- Assess before excluding: Avoid overly narrow criteria that reserve the unit for an idealized patient.
- Cover the full day: Overnight evaluation capacity prevents avoidable waiting and stalled transfers.
- Invest in adoption: Peer education and outside review help clinicians move beyond legacy habits.
- Measure operations and finances: Utilization, length of stay, placement time and reimbursement all determine sustainability.
Article Highlights
- MUSC increased adult EmPATH utilization from roughly 12% to nearly 40%.
- EmPATH became the default psychiatric destination, with the D-pod reserved as backup.
- Behavioral-health ED stays fell from 20–22 hours to roughly 12–13 hours.
- New overnight coverage created around-the-clock access to psychiatric evaluation.
Original Reporting
Read Ella Ruder’s complete reporting and operational details from Becker’s Behavioral Health.