The Impact of Behavioral Health Patients on a Pediatric Emergency Department's Length of Stay and Left Without Being Seen

Conrad, Heather; Hollenbach, Kathryn A.; Gehlbach, Daniel; Ferran, Karen; Barham, Tiffani A; Carstairs, Keri L.

doi:10.1097/pec.0000000000001565

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…MH presentations can strain already limited ED resources, this cohort is more likely to have recurrent ED presentations, 15,16 require an extended length of stay (LOS) and are more likely to need admission than children who present with a physical diagnosis 6,8,10,11 . Results from a recent Australian study had similar findings and also found that 22.5% of all paediatric MH presentations were for self‐harm 12 .…”

Section: What Is Already Known On This Topicmentioning

confidence: 74%

“…Australian emergency departments (EDs) are seeing an alarming increase in MH presentations across all ages with the most rapid increases in the paediatric population 4,5 . This trend is consistent globally and has been well studied in North America 6–11 . However in Australia, paediatric‐specific studies are limited 12–14 …”

Section: What Is Already Known On This Topicmentioning

confidence: 99%

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Mental health presentations to the paediatric emergency department: A retrospective study

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Carison

Hill

et al. 2021

J Paediatrics Child Health

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Aim To describe a cohort of patients aged 7–17 years presenting with mental health (MH) problems to an Australian tertiary paediatric emergency department (ED), in order to identify: (i) predictors of admission; and (ii) prolonged length of stay (LOS); (iii) reasons for ED presentation based on diagnosis and (iv) differences between major diagnostic groups. Methods Data for all presentations from 1 January 2018 to 31 December 2018 were extracted and analysed from the hospital's electronic medical record system. MH presentations were identified though rule‐based coding and manual file review. Results In this 12‐month period, 1071 children had 1690 emergency MH presentations constituting 6.7% of all ED presentations for children aged 7–17 years. Collectively, the leading cause for presentations was suicidal ideation, self‐harm or drug overdose (55%). Compared to discharged patients, admitted patients were more likely to be female (odds ratio (OR) 1.82, confidence interval (CI) 1.41–2.35), aged over 14–years (OR 2.50, CI 1.98–3.15), triaged with high acuity (OR 2.70, CI 2.00–3.65) and arrive by ambulance or police (OR 1.31, CI 1.04–1.64). The highest risk diagnosis associated with admission was eating disorders (OR 9.19, CI 5.48–15.40). Patients with a prolonged LOS (>8 h) were more likely to need admission (OR 5.38, CI 3.81–7.61) and be diagnosed with drug overdose (OR 2.39, CI 1.51–3.80) or acute behavioural disturbance (OR 1.61, CI 1.09–2.39). Conclusion Mental health presentations constitute a large proportion of ED presentations. Suicidal behaviour and self‐harm account for half of them. We have identified patients at increased risk of admission and prolonged ED LOS.

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Section: What Is Already Known On This Topicmentioning

confidence: 74%

Section: What Is Already Known On This Topicmentioning

confidence: 99%

Mental health presentations to the paediatric emergency department: A retrospective study

Say

Carison

Hill

et al. 2021

J Paediatrics Child Health

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“…First, the number of patients presenting with a MHD in paediatric EDs correlates with a longer ED-LOS for all other patients, and a higher rate of leftbefore-being-seen for the entire ED cohort. 3 For older patients with MHDs, an ED-LOS longer than 8 h carries a one in eight chance of developing an episode of delirium. 6 Long waits for patients with MHDs awaiting admission is a factor in overcrowding, 5,7 and correlates with poorer outcomes for staff, systems and patients alike.…”

Section: Introductionmentioning

confidence: 99%

“…In Canada, older patients with MHDs waited 48 min longer in ED than older patients without MHDs 2 . In the USA, this phenomenon appears to be of greater magnitude: patients waiting for a psychiatric bed in the USA have been found to wait between 5 and 12 h longer, depending on the study 3,4 . The ED patient journey is also different for patients with a MHD, and delays can occur at various timepoints unique to this population (Box 1).…”

Section: Introductionmentioning

confidence: 99%

“…A long ED‐LOS (LLOS) is not just an inconvenience for these patients; further deleterious effects have been demonstrated. First, the number of patients presenting with a MHD in paediatric EDs correlates with a longer ED‐LOS for all other patients, and a higher rate of left‐before‐being‐seen for the entire ED cohort 3 . For older patients with MHDs, an ED‐LOS longer than 8 h carries a one in eight chance of developing an episode of delirium 6 .…”

Section: Introductionmentioning

confidence: 99%

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Patients with mental health conditions in the emergency department: Why so long a wait?

Sweeny

Keijzers

O’Dwyer

et al. 2020

Emerg Medicine Australasia

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Objectives: Patients presenting with a mental health disorder (MHD) wait longer in the ED compared to those presenting for other reasons, potentially placing vulnerable patients at further risk for deterioration. The present study identified factors associated with a long ED stay for patients with a MHD. Methods: Linked ambulance, emergency, pathology, imaging and admission data for an 18-month period were analysed for ED presentations diagnosed with an MHD ICD-10 at a large teaching hospital. Admissions and discharges were considered separately; a long ED stay was defined as the 90th percentile length of stay. Multivariable generalised linear models were built, identifying predictors of a long ED stay for presentations diagnosed with a MHD. Results: The sample comprised 1163 admissions and 2242 discharges. For admissions, significant predictors for long ED stay were investigations (pathology or imaging tests), a triage score of 1 or 2, arrival out-of-hours (18.00-05.59 hours) and arrival by ambulance. For discharges, significant predictors of a long ED stay were investigations (pathology or imaging tests), arrival out-of-hours, arrival by ambulance and increasing age. Conclusions: Some factors predictive of a long ED stay for patients presenting to the ED and diagnosed with a MHD varied based on their disposition. For admissions, the most urgent presentations were likely to stay longest. Strategies to reduce ED stay for both admissions and discharges should consider addressing modifiable aspects, including the need for certain investigations, and nonmodifiable aspects, including the need for further access to afterhours mental health services in hospital and in the community.

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Mental Health Revisits at US Pediatric Emergency Departments

et al. 2023

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ImportancePediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts.ObjectiveTo describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits.Design, Setting, and ParticipantsIn this cohort study, data were obtained from 38 US children’s hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit.ExposuresCharacteristics of patients, encounters, hospitals, and communities.Main Outcomes and MeasuresThe primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression.ResultsThere were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit.Conclusions and RelevanceMarkers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.

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The Impact of Behavioral Health Patients on a Pediatric Emergency Department's Length of Stay and Left Without Being Seen

Cited by 10 publications

References 15 publications

Mental health presentations to the paediatric emergency department: A retrospective study

Mental health presentations to the paediatric emergency department: A retrospective study

Patients with mental health conditions in the emergency department: Why so long a wait?

Mental Health Revisits at US Pediatric Emergency Departments

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