The characteristics, management and outcomes of people identified with mental health issues in an emergency department, Melbourne, Australia

Abstract

Although the number of mental health presentations to emergency departments is increasing as a result of the integration of psychiatric services with general services, few studies have explored the characteristics of mental health patients presenting to emergency departments in Australia. This study investigated the characteristics of, and outcomes in relation to, people presenting with a mental health problem to one large metropolitan emergency department. Data were collected from the emergency department's electronic records system for adult patients aged 18-65 years old with an emergency department discharge diagnosis of a mental health disorder, including substance abuse and psychosocial crisis, for two months. Mental health patients totalled 5.3% (n= 290) of adult presentations to the emergency department. Over half were male; mean age 37.4 years; 49% were allocated triage category 3/urgent; 45% arrived by ambulance; 39% were overdosed/intoxicated and 55% received one or more diagnostic investigations. Patients who were intoxicated, those who arrived after hours, or patients admitted to a mental health ward were more likely to wait longer than 8h. Findings are broadly in line with that reported for other Australian studies, although the present findings suggest that patients had significantly more routine investigations and there were higher rates of presentations for 'intoxication'.

Patient characteristics associated with longer emergency department stay: a rapid review

“…No study of the general patient population considered specific physical diagnoses; one included broad diagnostic categories (which showed inconsistent effects across different segments of ED LOS),14 another reported that diagnoses were included in the analysis but provided neither definition nor results 10. Analyses of specific diagnoses or symptoms were more commonly undertaken in condition-specific studies,12 28 29 31 32 34 35 38 but the results may not be relevant to other populations. Other characteristics . Of the seven American studies that considered insurance status, most found longer stays among uninsured patients8 14 17 34 38 or those without private insurance,12 and two also found longer stays among Medicaid patients;14 38 one study of non-admitted patients reported that only Medicare patients had longer LOS 19.…”

“…No study of the general patient population considered specific physical diagnoses; one included broad diagnostic categories (which showed inconsistent effects across different segments of ED LOS),14 another reported that diagnoses were included in the analysis but provided neither definition nor results 10. Analyses of specific diagnoses or symptoms were more commonly undertaken in condition-specific studies,12 28 29 31 32 34 35 38 but the results may not be relevant to other populations.…”

Hospital Staff Nurse Perceptions of Competency to Care for Patients With Psychiatric or Behavioral Health Concerns

“…Emergency care nurses probably have the highest exposure to psychiatric emergencies because of the nature of their work environment and patient load. Between 5% and 13% of patients admitted to EDs have a psychiatric or chemical abuse problem (Owens, Mutter, & Stocks, 2010;Shafiei, Gaynor, & Farrell, 2011). According to California Health and Safety Code 1257.8, nurses who work in EDs must have training in management of assaultive behavior.…”

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

“…1-4 As a result, a significant number of psychiatric patients use EDs as their main entrance into the health care system [5][6][7][8] and as a source of primary care.…”