Exploring the experience of boarded psychiatric patients in adult emergency departments

Abstract

Background This study quantifies the frequency of adverse events (AEs) experienced by psychiatric patients while boarded in the emergency department (ED) and describes those events over a broad range of categories. Methods A retrospective chart review (RCR) of adult psychiatric patients aged 18–55 presenting to one of four Calgary EDs (Foothills Medical Centre (FMC), the Peter Lougheed Centre (PLC), the Rockyview General Hospital (RGH), and South Health Campus (SHC)) who were subsequently admitted to an inpatient psychiatric unit between January 1, 2019 and May 15, 2019 were eligible for review. A test of association was used to determine the odds of an independent variable being associated with an adverse event. Results During the study time period, 1862 adult patients were admitted from EDs (city wide) to the psychiatry service. Of the 200 charts reviewed, the average boarding time was 23.5 h with an average total ED length of stay of 31 h for all presentations within the sample. Those who experienced an AE while boarded in the ED had a significantly prolonged average boarding time (35 h) compared to those who did not experience one (6.5 h) (p = 0.005). Conclusions The length of time a patient is in the emergency department and the length of time a patient is boarded after admission significantly increases the odds that the patient will experience an AE while in the ED. Other significant factors associated with AEs include the type of admission and the hospital the patient was admitted from.

Incident of violence escalation of patients with psychiatric emergencies boarding in the emergency department in the central region of Thailand and its association: a prospective observational study

“…The number of psychiatric inpatient beds was not associated with violence escalation, probably because the correlation between the number of inpatient beds and violence escalation depended on waiting time in the emergency department. Similarly, previous research has shown that the lack of inpatient beds can lead to longer waiting times for psychiatric emergency department patients [ 22 ], which can increase the likelihood of violent incidents occurring [ 47 ].…”

Características clínicas en pacientes atendidos en una unidad de psiquiatría de emergencia en un hospital general de Perú

“…La hora de llegada de los pacientes fue un hallazgo interesante. Las horas más frecuentes de llegada de los pacientes fueron entre las 10:00 a.m. y las 12:00 p.m. Este resultado es diferente a los hallazgos de otros estudios que han encontrado que la mayoría de las admisiones psiquiátricas de emergencia ocurren durante la noche y la madrugada (5,9,26) . Se necesitan más estudios para determinar si este resultado es específico del contexto de este hospital o si refleja un patrón más general en la demanda de atención psiquiátrica de emergencia del Perú.…”

“…Estos resultados sugieren que la accesibilidad a la atención psiquiátrica en entornos médicos requiere mejo-ras (8) . Además, el abordaje de pacientes con trastornos mentales en los servicios de emergencia es subóptimo debido a la falta de recursos y entornos terapéuticos disponibles, lo que retrasa el inicio del tratamiento y causa impactos posteriores en los tiempos de espera en la emergencia y cuellos de botella para otros servicios de emergencia (9) . En el contexto peruano, la atención de emergencias psiquiátricas se rige por las normativas y guías establecidas por el Ministerio de Salud (MINSA).…”

Psychiatric care in the emergency department: Converting boarding time to treatment time

“…An observation study by Bakhsh et al 5 showed that 65% of patients boarding in the ED for psychiatric complaints had a medication error requiring an intervention, with 89% of them being errors of omission. Furthermore, a retrospective study by Major et al 6 showed that patients who experienced an adverse event such as physical and chemical restraints, security personnel intervention, and verbal or physical assault had a significantly prolonged boarding time (35 h vs. 6.5 h, p < 0.005).…”

“…Furthermore, a retrospective study by Major et al 6 showed that patients who experienced an adverse event such as physical and chemical restraints, security personnel intervention, and verbal or physical assault had a significantly prolonged boarding time (35 h vs. 6.5 h, p < 0.005).…”