Hospital Variability in Emergency Department Length of Stay for Adult Patients Receiving Psychiatric Consultation: A Prospective Study

Chang, Grace; Weiss, Anthony P.; Orav, E. John; Jones, Jennifer A.; Finn, Christine; Gitlin, David; Haimovici, Florina; Hazen, Eric P.; Kosowsky, Joshua M.; Schechter, Mark; Rauch, Scott L.

doi:10.1016/j.annemergmed.2010.12.003

Cited by 55 publications

(48 citation statements)

References 26 publications

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“…As part of a cohort study of 1000 adults with psychiatric illness who presented to the ED of one of five study hospitals, a subset of patients (N=863) presenting to four of the five hospitals was available for this analysis [26]. The fifth hospital was not included in this study because it initiated a pilot case management program to address the frequent ED visitor once data collection for the parent study was complete [27].…”

Section: Methodsmentioning

confidence: 99%

“…Cases were eligible for inclusion if the patients were adults, aged 18 years or older, and assessed to have a primary psychiatric problem or complaint after medical evaluation. Additional details are available elsewhere [26]. The percent of annual ED visits that were primarily psychiatric ranged from 1 The ED visit in which the patient was enrolled in the broader study served as an index visit for the purposes of the present analysis.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of frequent emergency department use among patients with psychiatric illness

Chang

Weiss

Orav

et al. 2014

General Hospital Psychiatry

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Predictors of frequent emergency department use among patients with psychiatric illness

Chang

Weiss

Orav

et al. 2014

General Hospital Psychiatry

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“…The causes of longer LOSs for psychiatric patients have been ascribed to several causes often not under the control of ED physician or staff, including patients presenting with suicidal or homicidal ideation, inpatient bed availability, the organization of the psychiatry service/willingness to conduct regular rounds, and day of the week [5,6,[11][12][13][14]. Only 2 factors that are reasonably within the control of typical ED clinicians, including the length of time before specialist evaluation is requested and restraint use, have been associated with longer LOSs [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Only 2 factors that are reasonably within the control of typical ED clinicians, including the length of time before specialist evaluation is requested and restraint use, have been associated with longer LOSs [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

Wilson¹,

Brennan²,

Modesti³

et al. 2015

The American Journal of Emergency Medicine

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Background: Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS. Methods: A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS. Results: Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends. Conclusions: Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.

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“…28 Se conoce poco sobre los efectos con la utilización o la falta de un procedimiento de triage en un servicio de urgencias psiquiátricas, especialmente si se toma en cuenta que la actividad de un servicio a otro puede ser extremadamente variable. 29 Teniendo en consideración la falta de estudios sobre la utilización de servicios de urgencias en hospitales psiquiá-tricos en México, realizamos el presente trabajo que tuvo como objetivo describir y comparar los indicadores de actividad para diferentes períodos en un servicio de urgencias psiquiátricas mexicano durante los años 2004 a 2008, en el que aún no se había implementado un procedimiento de clasificación de urgencias psiquiátricas (triage), y en el que el único criterio de atención era la solicitud de atención voluntaria por parte de los usuarios que consideraron ameritar una consulta de urgencias durante el período de estudio.…”

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Indicadores de actividad durante cinco años en un servicio de urgencias de atención voluntaria de un hospital psiquiátrico mexicano

et al. 2014

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Introducción. Los Servicios de Urgencias Psiquiátricas (SUP) han reportado incremento en su demanda en los últimos anos. Se desconoce sobre los indicadores de actividad en SUP en hospitales psiquiátricos mexicanos. Se necesitan estudios que describan la actividad de estos servicios, especialmente los de atención voluntaria y sin procedimiento de valoración de la gravedad de las urgencias (triage) previo a la consulta. Objetivos. Describir y comparar los Indicadores de Actividad en un SUP de un hospital psiquiátrico de la Ciudad de México durante cinco años, en el que se ofreció atención voluntaria sin procedimiento de triage. Material y métodos. Se analizo una base de datos del SUP de todas las consultas otorgadas del 1o de enero de 2004 al 31 de diciembre de 2008. Se determinaron el total de consultas y las frecuencias relativas trimestral, semestral, anual y quinquenal desglosados por variables de utilización de servicio y diagnostico psiquiátrico según la CIE-10. Resultados. Se atendieron un total de n=41 058 consultas durante el quinquenio, encontrando incremento de 14.8% en la actividad global en el periodo. Se observo un incremento significativo de la proporción de pacientes sin adherencia a consulta externa así como mayor afluencia en el turno nocturno, mientras que la proporción de referencias y hospitalizaciones disminuyo más del 4%, sugiriendo aumento “en bola de nieve” de usuarios frecuentadores con condiciones no urgentes. No se encontraron cambios en la proporción de los diagnósticos psiquiátricos a lo largo del tiempo, pero hubo un aumento significativo del 9.69% en la actividad global en el primer semestre respecto del segundo. Discusión. La atención voluntaria sin procedimiento de triage tiende a generar mayor afluencia de pacientes frecuentadores con condiciones no urgentes, sobresaturando el servicio y desfavoreciendo las condiciones urgentes, especialmente durante el primer semestre del año.

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Hospital Variability in Emergency Department Length of Stay for Adult Patients Receiving Psychiatric Consultation: A Prospective Study

Cited by 55 publications

References 26 publications

Predictors of frequent emergency department use among patients with psychiatric illness

Predictors of frequent emergency department use among patients with psychiatric illness

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

Indicadores de actividad durante cinco años en un servicio de urgencias de atención voluntaria de un hospital psiquiátrico mexicano

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