Assessing quality indicators related to mental health emergency room utilization

Abstract

BackgroundThis descriptive study compared 2014–15 to 2005–06 data on the quality of mental health services (MHS) in relation to emergency room (ER) use to assess the impact of the 2005 Quebec MH reform regarding access, continuity and appropriateness of care for patients with mental illnesses (PMI).MethodsData emanated from the Quebec Integrated Chronic Disease Surveillance System (Quebec/Canada). Participants (865,255 for 2014–15; 817,395 for 2005–06) were age 12 or over, with at least one MI, including substance use disorders (SUD), diagnosed during an ER visit, outpatient treatment or hospitalization. Variables included: access (ER use/frequency, hospitalization rates, outpatient consultations preceding an ER visit), care continuity (outpatient consultations following an ER visit/hospitalization, consecutive returns to the ERs), and care appropriateness (high ER use, recurrence of yearly ER visits, length of hospitalization). Frequency distributions were calculated on sex, age and geographic area for ER visits/hospitalizations in 2014–15, and between 2014 and 15 and 2005–06.ResultsPMI accounted for 12 % of the Quebec population in 2014–15 (n = 865,255), of whom 39% visited an ER for any reason. Amount and frequency of ER use and number/length of hospitalizations were almost twice as high for PMI versus patients without MI; 17% of PMI were also high/very high ER users and were frequently hospitalized. Among PMI, ER users were also frequent users of outpatient services despite a lack of follow-up appointments after ER visits or hospitalizations. Findings revealed some positive changes over time, such as decreased ER and hospitalization rates; yet overall access, continuity and appropriateness of care, as measured in this study, remained low.ConclusionsThis study demonstrated that the Quebec reform did not produce a substantial impact on ER use or substantially improved care, as hypothesized. Better access and continuity of care should be promoted to reduce the high prevalence of ER use among PMI. Quality improvement in MHS may be realized if ERs are supported by substantial and well-integrated community MH networks.

Typology of patients who use emergency departments for mental and substance use disorders

“…56 Moreover, the frequency of individuals with high emergency department use in class 2 was quite similar to that for the general Quebec population (17%), according to administrative data. 57 Some classes identified in our study show similarities with those of previous studies that assessed very distinct samples of people with MD-SUD. For example, one study of 4526 individuals receiving services from an addiction rehabilitation center 48 identified a class of individuals with multiple MDs and SUDs and high emergency department use that bore some resemblance to our class 2.…”

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

“…Currently the effectiveness of community-and primary-care-based interventions for limiting ED use for psychiatric illness is not well understood [29,30]. This is an area in need of focused attention, as well as carefully planned and evaluated interventions to improve patient outcomes and possibly lead to cost savings [31][32][33]. However, the amount and quality of published literature that has evaluated urgent psychiatric services is exceedingly limited, especially from European countries.…”

Patients with mental health conditions in the emergency department: Why so long a wait?

“…These findings are not surprising as a requirement for admission is recognised as a predictor for a LLOS 1,23,24,26,27 . Moreover, patients presenting with MHDs have about double the admission rates observed for other patients 23–25,28 …”

“…In our study, 34.2% of patients presenting with a MHD were admitted to hospital, similar to estimates from other studies from Australia, Canada and the USA. [23][24][25] Admissions waited longer than discharges, with a median LOS 1.4 h longer for admissions. These findings are not surprising as a requirement for admission is recognised as a predictor for a LLOS.…”

“…1,23,24,26,27 Moreover, patients presenting with MHDs have about double the admission rates observed for other patients. [23][24][25]28 Some independent risk factors for a LLOS were consistent regardless of discharge disposition: that is, afterhours arrival and arrival by ambulance: both risk factors may be modifiable with changes in service delivery. After-hours arrival predominantly influences the mental health assessment component of ED-LOS, wherein specialist mental health resources may be required to determine ultimate safety for discharge or need for admission.…”