Impact of the Mental Health Care Delivery System on California Emergency Departments

Stone, Ashley; Rogers, Debby; Kruckenberg, Sheree; Lieser, Alexis

doi:10.5811/westjem.2011.6.6732

Cited by 29 publications

(31 citation statements)

References 15 publications

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“…The median LOSs reported in this study are long (840 min) and are actually longer than those reported by similar studies of psychiatric patients (Weiss et al [13], for instance, documented a mean LOS of 690 min). Given the extraordinary wait times experienced by psychiatric patients, it is important to document factors associated with increased LOSs [23].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Seven hospitals in Florida provide inpatient psychiatric services without designation as a Receiving Facility. This scenario of transferring patients with psychiatric needs generates the greatest proportion of delays to psychiatric care nationwide (Hazlett, McCarthy, Londner, & Onyike, 2004;Nicks & Manthey, 2012;Slade, Dixon, & Semmel, 2010;Stone, Rogers, Kruckenberg, & Lieser, 2012;Weiss et al, 2012). Christy (2008) noted anecdotal evidence that some people requiring involuntary examinations remain in EDs for most or all of their 72-h involuntary examination period waiting for bed availability at a Receiving Facility.…”

Section: Federal Law and Emergency Mental Health Servicesmentioning

confidence: 95%

Exceeding the Legal Time Limits for Involuntary Mental Health Examinations

Brennaman

2015

Policy, Politics, & Nursing Practice

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This study addressed delays to involuntary mental health examinations experienced by individuals in emergency departments (EDs). Florida statute specifies that involuntary mental health examinations shall take place only at state-designated facilities "without unnecessary delay"-no longer than 12 h until transfer-for individuals in hospital EDs. Individuals in EDs needing involuntary mental health examinations sometimes wait for admission to inpatient units because of unavailability of mental health services. Data collectors at two hospitals reviewed the records of 170 randomly selected ED patients requiring involuntary mental health examinations. Nearly one-half (48.8%) of participants waited longer than the 12-h maximum allowed by Florida law for transfer to an authorized facility. Factors that associated with prolonged waits were being male, increased age, being a Medicare beneficiary, and being intoxicated. State agencies responsible for the regulation of hospitals and mental health facilities should use this data and engage front-line caregivers to identify statutory remedies.

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“…Shrinking bed capacity is a national problem6,10,11 and pronounced in our state of Washington, which has lost almost 16% of its inpatient beds since 2000, even as its population has grown by 14% 12,13…”

Section: Introductionmentioning

confidence: 99%

Who's Boarding in the Psychiatric Emergency Service?

Simpson¹,

Joesch²,

West³

et al. 2014

WestJEM

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IntroductionWhen a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described.MethodsWe electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression.Results521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis.ConclusionBoarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients.

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Impact of the Mental Health Care Delivery System on California Emergency Departments

Cited by 29 publications

References 15 publications

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

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

Exceeding the Legal Time Limits for Involuntary Mental Health Examinations

Who's Boarding in the Psychiatric Emergency Service?

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