Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

Abstract

Objective: To describe the patterns of referral and use of resources for patients with psychiatric-related visits presenting to pediatric emergency departments (EDs) in a pediatric research network. Methods:We conducted a retrospective chart review of a random sample of patients (approximately 10 charts per month per site) who presented with psychiatric-related visits in 2002 to 4 pediatric EDs in the Pediatric Emergency Care Applied Research Network. Emergency department resource use variables evaluated included the use of consultation services, restraints, and laboratory tests as well as ED length of stay.Results: We reviewed 462 patient visits with a psychiatric-related ED diagnosis. Mean (SD) age was 12.8 (3.7) years, 52% were male, and 49% were African American. The most common chief complaints were suicidality (47%), aggression/agitation (42%), and anxiety/depression (27%), alone or in combination. Ninety percent of patients (range across sites, 83%Y94%) had a mental health consult in the ED, 5% were restrained (range, 3%Y9%), and 35% had a laboratory test performed (range, 15%Y63%). Mean (SD) ED length of stay was 5.1 (5.4) hours, and 52% were admitted (93% to a psychiatric bed, including transfers to separate psychiatric facilities). Conclusions:Children with psychiatric-related visits seem to require substantial ED resources. Interventions are needed to reduce the burden on the ED by increasing the linkage to mental health services, particularly for suicidal youths.

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

“…The rate of admission to the inpatient psychiatric unit for this sample was 25.1%, which is lower than the rates reported by Grupp-Phelan et al (29) of 48%, Santiago et al (20) of 49.5%, and Frosch et al (30) of 55%. The common features of these studies are high incidences of prior contact with the mental health system and suicidal tendencies, suggesting that many of the patients need further urgent treatment and therefore were appropriately referred to EDs.…”

Emergency Presentations to an Inner-city Psychiatric Service for Children and Adolescents

“…Hospitalisation on a psychiatric ward occurred rarely (1.9%), compared with other studies that found admission rates of 8Á52% (Grupp-Phelan et al, 2009;Healy et al, 2002;Santiago et al, 2006). One might question whether this represents a realistic need for psychiatric treatment or a lack of adequate psychiatric evaluation and facilities in emergency situations.…”

“…Another characteristic that may assist in comparison of studies and healthcare systems is to specify the referral patterns and service-uptake resulting from consultations (Grupp-Phelan et al, 2009;Healy et al, 2002). Earlier studies often did not provide this evidence.…”

The Acceptability of Mental Health Screening in a Pediatric Emergency Department

“…On the few occasions where mental health referrals were necessary in the current study, ED providers were more than willing to facilitate acute psychiatric evaluation. Similar to many PEDs, 26 psychiatric social workers in our ED were available to efficiently assess risk and provide referral assistance 24 hours a day once a problem was uncovered. Our study has some potential limitations.…”