Background
During the COVID-19 pandemic, there have been an increasing number of emergency department (ED) visits for behavioral health reasons, even as overall ED volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high intensity care for severely ill patients who are likely to be homeless and underserved.
Objective
We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States.
Methods
Change in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020.
Results
The pandemic’s impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance.
Conclusion
There has been a decrease in volume at these service after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.
Objectives
We describe the Columbia‐Suicide Severity Rating Scale (C‐SSRS)–Clinical Practice Screener’s ability to predict suicide and emergency department (ED) visits for self‐harm in the year following an ED encounter.
Methods
Screening data from adult patients’ first ED encounter during a 27‐month study period were analyzed. Patients were excluded if they died during the encounter or left without being identified. The outcomes were suicide as reported by the state health department and a recurrent ED visit for suicide attempt or self‐harm reported by the state hospital association. Multivariable regression examined the screener’s correlation with these outcomes.
Results
Among 92,643 patients analyzed, eleven (0.01%) patients died by suicide within a month after ED visit. The screener’s sensitivity and specificity for suicide by 30 days were 0.18 (95% confidence interval [CI] = 0.00 to 0.41) and 0.99 (95% CI = 0.99 to 0.99). Sensitivity and specificity were better for predicting self‐harm by 30 days: 0.53 (95% CI = 0.42 to 0.64) and 0.97 (95% CI = 0.97 to 0.97), respectively. Multivariable regression demonstrated that screening risk remained associated with both suicide and self‐harm outcomes in the presence of covariates. Suicide risk was not mitigated by hospitalization or psychiatric intervention in the ED.
Conclusions
The C‐SSRS screener is insensitive to suicide risk after ED discharge. Most patients who died by suicide screened negative and did not receive psychiatric services in the ED. Moreover, most patients with suicidal ideation died by causes other than suicide. The screener was more sensitive for predicting nonfatal self‐harm and may inform a comprehensive risk assessment. These results compel us to reimagine the provision of emergency psychiatric services.
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