Case-Control Study of Frequent Visitors to an Urban Psychiatric Emergency Service

Arfken, Cynthia L.; Zeman, Lori Lackman; Yeager, Lindsay; White, Aja; Mischel, Edward; Amirsadri, Alireza

doi:10.1176/appi.ps.55.3.295

Cited by 57 publications

(70 citation statements)

References 26 publications

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“…The characterization of clinical features over the course of service use is also lacking. Given that many return ED users already have access to mental health services, 41,[51][52][53][54] such studies would help to clarify the role of the ED along the service and illness continuums.…”

Section: Discussionmentioning

confidence: 99%

Who Comes Back? Characteristics and Predictors of Return to Emergency Department Services for Pediatric Mental Health Care

Newton

Ali²,

Johnson³

et al. 2010

Academic Emergency Medicine

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Objectives: The objective of this study was to investigate predictors of emergency department (ED) return visits for pediatric mental health care. The authors hypothesized that through the identification of clinical and health system variables that predict return ED visits, which children and adolescents would benefit from targeted interventions for persistent mental health needs could be determined.Methods: Data on 16,154 presentations by 12,589 pediatric patients (£17 years old) were examined from 2002 to 2006, using the Ambulatory Care Classification System (ACCS), a provincewide database for Alberta, Canada. Multivariable logistic regressions identified predictors, while survival analyses estimated time to ED return. Results:In the multivariable analysis, there were four patient factors significantly associated with ED return. Male sex (odds ratio [OR] = 0.78; 99% confidence interval [CI] = 0.69 to 0.89) was associated with a lower rate of return, as was child age. The likelihood of ED return increased with age. Children £5 years (OR = 0.26; 99% CI = 0.14 to 0.46) and between ages 6 and 12 (OR = 0.64; 99% CI = 0.51 to 0.79) were less likely to return, compared to 13-to 17-year-olds. Patients with families receiving full assistance for covering government health care premiums were more likely to return compared to those with no assistance (OR = 1.59; 99% CI = 1.33 to 1.91). Patients were more likely to return if their initial presentation was for a mood disorder (OR = 1.72; 99% CI = 1.46 to 2.01) or psychotic-related illness (OR = 2.53; 99% CI = 1.80 to 3.56). There were two modest health care system predictors in the model. The likelihood of return decreased for patients triaged as nonurgent (OR = 0.62; 99% CI = 0.45 to 0.87) versus those triaged as urgent (level 3 acuity) and increased for patients with visits to general (vs. pediatric) EDs (OR = 1.25; 99% CI = 1.03 to 1.52). ED region (urban vs. rural) did not predict return. Within 72 hours of discharge, 6.1 and 8.7% of patients diagnosed with a mood disorder and psychotic-related illness, respectively, returned to the ED. Throughout the study period, 28.5 and 36.6% of these diagnostic populations, respectively, returned to the ED.Conclusions: Among children and adolescents who accessed the ED for mental health concerns, being female, older in age, in receipt of social assistance, and having an initial visit for a mood disorder or psychotic-related illness were associated with return for further care. How patient presentations were triaged and whether visits were made to a pediatric or general ED also affected the likelihood of return.

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Section: Discussionmentioning

confidence: 99%

Who Comes Back? Characteristics and Predictors of Return to Emergency Department Services for Pediatric Mental Health Care

Newton

Ali²,

Johnson³

et al. 2010

Academic Emergency Medicine

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“…This literature has identified predictors of repeated ED visits for mental health reasons including several socio-demographic, diagnostic and service use characteristics including: male gender [16,17], younger age [3,12,17,18], black or Hispanic race [12], unemployment [19,20], low income [3,17,18,21], homelessness [21,22], living alone [23], lacking social support [22], schizophrenia [3,12,18,20], psychosis [17,20], personality disorder [19,22,25], substance abuse [12,17,20,25], developmental delay [22], prior hospitalizations [21,22,24], history of detoxification [22], recent and increased use of outpatient treatment [21], current psychiatric treatment [25], and a history of incarceration [21].…”

Section: Introductionmentioning

confidence: 99%

“…One study found anxiety, homicidal ideation, self-injurious behavior, intoxication and an absent or vacationing psychotherapist were associated with frequent ED use [25]. Another study found that the need for medication was predictive of frequent ED use [21]. Identification of patient service needs in additional to socio-demographic and diagnostic predictors may serve to inform the development of clinical and system-based interventions that engage frequent presenters in community-based care and alleviate pressure on ED services.…”

Section: Introductionmentioning

confidence: 99%

Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

Sirotich

Durbin

2016

Soc Psychiatry Psychiatr Epidemiol

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The repeat ED user group within case management may have distinct need profiles that require different treatment responses. Moreover, clinical needs rather than psychosocial needs have the greatest relationship with repeat psychiatric ED utilization. These unmet needs suggest areas for future interventions aimed at reducing the use of ED services for mental health reasons and improving care for patients who repeatedly present at the ED.

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“…As repeated attendance to the A&E department for psychiatric care is not an optimal treatment strategy, and hospital beds are at a massive premium, it is imperative for mental health services to carefully evaluate the quality, appropriateness and effectiveness of available community services to better target the needs of frequent users of hospital-based services. 3 Well-developed community-oriented strategies, such as modified intensive case management and outreach programmes, which have been shown to reduce the heavy use of psychiatric in-patient services, 8 could also help limit frequent attenders' visits by reducing social instability and increasing treatment adherence. 6 …”

Section: Discussionmentioning

confidence: 99%

“…Individuals who frequently attend A&E for psychiatric care have been characterised by other studies 3,4 as being younger males, of Black and minority ethnic background, unmarried, unemployed, and being more likely to have diagnoses of personality disorders and substance misuse. The aim of our study was to identify the clinical characteristics of patients who frequently attend for emergency psychiatric assessment and treatment at the A&E department of the University College Hospital in Galway, Ireland.…”

mentioning

confidence: 99%

Patients repeatedly attending accident and emergency departments seeking psychiatric care

2011

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Attendance at accident and emergency (A&E) departments by patients seeking psychiatric care is quite common as A&E departments usually provide crisis intervention as well as serve as an entry point for hospital admission. 1,2 However, some patients repeatedly attend A&E seeking assessment and psychiatric care. These patients may have unmet mental health needs that require more service input. Identifying the clinical characteristics of this patient group and targeting them with more suitable care strategies may reduce such frequent visits to the A&E department.Individuals who frequently attend A&E for psychiatric care have been characterised by other studies 3,4 as being younger males, of Black and minority ethnic background, unmarried, unemployed, and being more likely to have diagnoses of personality disorders and substance misuse. The aim of our study was to identify the clinical characteristics of patients who frequently attend for emergency psychiatric assessment and treatment at the A&E department of the University College Hospital in Galway, Ireland. Emergency psychiatric care at the hospital is shared between a psychiatric emergency liaison team and the out-of-hour duty psychiatric doctors. Ongoing care is provided in the community or acute psychiatric unit by various multidisciplinary teams. We identified patients who received emergency psychiatric care in the A&E department three or more times in a 6-month period and compared their demographic and clinical characteristics with those who received such care only once in the same period. We also examined the relationships between frequent A&E attendance for psychiatric care and hospital admission. MethodAll patients who presented to the A&E department seeking emergency psychiatric care from 1 July to 31 December 2007 were identified. The number of times each patient had attended over that period was tabulated and those who attended frequently were identified.Frequent attenders were defined as those patients who presented for psychiatric care three or more times, whereas single attenders accessed psychiatric care only once within this 6-month period. The threshold of three visits was selected as being likely to represent a subgroup of patients with higher than average visiting profile. Three or more visits were in excess of the 95th percentile for attendances to the A&E department for psychiatric care.Each frequent attender was compared with three randomly selected single attenders matched by age (5-year age bands) and gender. Random selection of the single attenders was based on computer-generated random numbers. In all, 26 frequent attenders were identified; however, data were available for only 24 of them (92.3%). These were then matched with 72 single attenders. The psychiatric records of the 96 individuals were then examined. The information collected for each patient included: Aims and method This study was conducted to ascertain the clinical characteristics of patients who repeatedly attend accident and emergency (A&E) department seeking psychiatric ...

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Case-Control Study of Frequent Visitors to an Urban Psychiatric Emergency Service

Abstract: Frequent visitors represent resource-poor mentally ill persons who have high levels of utilization of health care facilities besides psychiatric emergency services. Possible clinical interventions for these patients include focused medication reviews.

Cited by 57 publications

References 26 publications

Who Comes Back? Characteristics and Predictors of Return to Emergency Department Services for Pediatric Mental Health Care

Who Comes Back? Characteristics and Predictors of Return to Emergency Department Services for Pediatric Mental Health Care

Examining the need profiles of patients with multiple emergency department visits for mental health reasons: a cross-sectional study

Patients repeatedly attending accident and emergency departments seeking psychiatric care

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