Biopsychosocial Health Care Needs at the Emergency Room: Challenge of Complexity

Abstract

BackgroundIn an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment.MethodsDuring a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment.ResultsStudy participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters.ConclusionsA standardized screening of biopsychosocial case complexity among ‘frequent utilizers’ of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.

The highest utilizers of care: Individualized care plans to coordinate care, improve healthcare service utilization, and reduce costs at an academic tertiary care center

“…High utilizers of hospital services are medically complex, psychosocially vulnerable, and at risk for adverse health outcomes . They make up a fraction of the patient population but use a disproportionate amount of resources, with high rates of emergency department (ED) visits and hospital admissions .…”

Biopsychosocial aspects and the complexity of care of hospitalized elderly

“…There must be a model that meets the care model, beyond the interests of the marketplace, which consists of the organization of actions to intervene in the health-disease process, articulating physical, technological and human resources in an attempt to achieve the resolution of health problems in a collective manner. (26)(27)(28) It is necessary to rethink the responsibilities of the institutions facing the actual demands of the society and of the professionals in various areas of care for the elderly, families and communities, in order to introduce changes in the care model and social support equipment.…”

Why go to the Emergency Room? A Patient Decision Making Process

“…Many studies reveal the type of people that often use emergency services when not needed. One study shows high usage rates occur by patients living alone with limited social networks, who might be better served by nonurgent services [7]. Still other studies make the determination more complex-such as high visit groups related to alcohol use [5], or psychiatric needs [13,14], as well as conditions such as PTSD, mood disorders, and anxiety [15].…”

“…State efforts are directed at encouraging hospitals to develop new strategies to reduce the number of patients using emergency rooms as a primary source of care. This high-use group of patients is known as -high flyers.‖ High usage by select groups of patients is not limited to the United States, so this work might also offer some insight for international medical care [7]. As part of a larger work, the purpose of this case study is to build a decision making model of the factors patients consider in seeking emergency services, as well as the role and relationships of these factors to each other.…”