Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments

Pearlmutter, Mark; Dwyer, Kristin H.; Burke, Laura; Rathlev, Niels K.; Maranda, Louise; Volturo, Gregory A.

doi:10.1016/j.annemergmed.2016.10.005

Cited by 71 publications

(63 citation statements)

References 19 publications

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“…Importantly, we did not ask or assess the patients for mitigating factors that could be causing their acute anxiety. Waiting times, overcrowding, previous adverse experiences, or intercurrent illnesses could all contribute to severe distress . While art therapy represents an opportunity for better ED care at a low cost, we should not assume that a universal provision of this therapy would be either appropriate or effective.…”

Section: Discussionmentioning

confidence: 99%

“…Waiting times, overcrowding, previous adverse experiences, or intercurrent illnesses could all contribute to severe distress. 33 While art therapy represents an opportunity for better ED care at a low cost, we should not assume that a universal provision of this therapy would be either appropriate or effective. Qualitative research on patient experiences with art therapy have revealed that a natural resistance to engagement in art therapy may evoke negative experiences for the patient.…”

Section: Discussionmentioning

confidence: 99%

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Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

Rajendran

Mitra

Shahrestani

et al. 2020

Academic Emergency Medicine

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Background Anxiety and acute distress are significant concerns in the emergency department (ED). Adult coloring books are often utilized as an effective means of relaxation in waiting rooms and newsstands, but there are no reported randomized trials examining their effectiveness as a treatment for anxiety. Methods We set out to examine the effectiveness of adult coloring books using a randomized placebo‐controlled trial at a university‐affiliated tertiary ED. Anxiety was measured using a validated self‐reporting score, the Hospital Anxiety and Depression Scale (HADS‐A), with a range of 0 to 21. Patients with HADS‐A ≥ 7 were randomly assigned to either an adult coloring pack (n = 26) or placebo pack (n = 27). The primary outcome measure was the within‐patient change in HADS‐A scores following 2 hours of exposure. Results A convenience sample of 117 patients were screened, and 53 patients were randomized. Characteristics of allocated groups were similar in terms of sex, diagnosis, and ethnicity. A higher proportion of intervention subjects spent ≥1 hour engaged with their activity (46.2% vs. 4.0%, p = 0.01). For the primary outcome measure, the mean within‐patient decrease in HADS‐A score at 2 hours for intervention subjects was 3.7 (95% confidence interval [CI] = 2.4 to 5.1, p < 0.001) versus a decrease of 0.3 (95% CI = –0.6 to 1.2, p = 0.51) in the placebo group. Conclusions Among ED patients, exposure to adult coloring books resulted in lower self‐reported levels of anxiety at 2 hours compared to placebo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

Rajendran

Mitra

Shahrestani

et al. 2020

Academic Emergency Medicine

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“…Increased ED psychiatric visits in states with poor psychiatric resources can result in significantly longer ED visits and poorer mental health outcomes. 54 The UCHED study showed a 30% (increase from 75 to 103/100,000 visits) increase over the time period, which can have direct impact on hospital systems if they can be prevented. While this increase was not statistically significant in the UCHED data set, likely due to the smaller population, a significantly increased rate was identified in the larger, CHAED data set.…”

Section: Discussionmentioning

confidence: 99%

Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado

Hall

Monte

Chang

et al. 2018

Academic Emergency Medicine

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Background Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review. Methods We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time. Results Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27–5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36–5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001). Conclusions In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.

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“…Therefore, the aged person appears to be at a distinct disadvantage when presenting to the ED with a mental health related problem. Individuals of all ages waiting for mental health beds are associated with longer ED-LOS [23] and individuals who are older have a further disadvantage of greater ED-LOS, regardless of presenting factors [18,24]. Thus, an older person with a behavioural disturbance in the ED automatically incurs this twofold disadvantage, resulting in exacerbated ED-LOS.…”

Section: Introductionmentioning

confidence: 99%

Delays in admitting aged persons to the mental health ward from the emergency department

Donley¹

2019

Emerg Med Health Care

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Emergency Departments (EDs) continue to experience a rise in presentations and an even greater rise in mental health presentations. An older person in a mental health crisis presenting to the ED is more likely to experience comorbidities and a longer ED length of stay (ED-LOS). This results in poorer outcomes for the individual and the organisation. Many older persons in this scenario undergo comprehensive organic screening to exclude any organic cause for their presentation. This mixed methods analysis audited hospital files over a one-year period, examining the reasons for ED-LOS. A large proportion of the aged population required organic screening, resulting in longer ED-LOS, despite mental health bed availability. This study acknowledges that organic screening of any mental health person is of important value; however, notes that screening appears to be determined by age rather than clinical presentation and at times be better suited outside of the ED.

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Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments

Cited by 71 publications

References 19 publications

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

Randomized Controlled Trial of Adult Therapeutic Coloring for the Management of Significant Anxiety in the Emergency Department

Mental Health–related Emergency Department Visits Associated With Cannabis in Colorado

Delays in admitting aged persons to the mental health ward from the emergency department

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