The Impact of Mental Health Services in a Pediatric Emergency Department

Holder, Sharon M.; Rogers, Kenneth M.; Peterson, Eunice; Shoenleben, Robbie; Blackhurst, Dawn W.

doi:10.1097/pec.0000000000000836

Cited by 18 publications

(46 citation statements)

References 13 publications

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“…The studies included in this scoping review were published within the last ten years (2010 to 2021). Twenty studies were observational (non-interventional) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ] and the rest were interventional studies [ 45 , 46 , 47 , 48 , 49 , 50 ]. There were twenty-three studies conducted in North America (88.5%) [ 25 , 26 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ], while two were conducted in Europe [ 27 , ...…”

Section: Resultsmentioning

confidence: 99%

Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

“…The studies included in this scoping review were published within the last ten years (2010 to 2021). Twenty studies were observational (non-interventional) [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and the rest were interventional studies [45][46][47][48][49][50]. There were twenty-three studies conducted in North America (88.5%) [25,26,[28][29][30][31][32][33][34][35][36][39][40][41][42][43][44][45][46][47][48][49], while two were conducted in Europe [27,…”

Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

“…Among the 26 studies under review, n = 6, 23.07% discussed interventions involving multidisciplinary coordinated care, including HAP [26], PCMH [25], PBHCI [44], FHMC [28], MCC [30], and the Floresco's model [50]; In a total of 7 studies, 26.92% of the studies focused on interventions using various health services resources and seeking government assistance, including HEARTSMAP [45], QI [40], PAO [35], ACA [36], BHH [46], the model of Having Trained Psychiatric Professionals [31], and the rapid-access ambulatory psychiatric care [33]; n = 2, 7.69% of the studies addressed pharmacy-related methods, which are TOC [39] and PMEGs [42]; n = 2, 7.69.% discussed case management strategies, such as ICM [48] and CALM [34]; the remaining (n = 9, 34.63%) emphasized other types of intervention programs (Figure 4). Among the 26 studies under review, n = 6, 23.07% discussed interventions involving multidisciplinary coordinated care, including HAP [26], PCMH [25], PBHCI [44], FHMC [28], MCC [30], and the Floresco's model [50]; In a total of 7 studies, 26.92% of the studies focused on interventions using various health services resources and seeking government assistance, including HEARTSMAP [45], QI [40], PAO [35], ACA [36], BHH [46], the model of Having Trained Psychiatric Professionals [31], and the rapid-access ambulatory psychiatric care [33]; n = 2, 7.69% of the studies addressed pharmacy-related methods, which are TOC [39] and PMEGs [42]; n = 2, 7.69.% discussed case management strategies, such as ICM [48] and CALM [34]…”

Section: Target Conditions and Intervention Typementioning

confidence: 99%

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Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

2023

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Background: The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. Object: This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. Method: The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. Result: This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. Conclusion: Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.

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Section: Resultsmentioning

confidence: 99%

Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

Section: Published Time Type and Conducted Countries Of The Extracted...mentioning

confidence: 99%

Section: Target Conditions and Intervention Typementioning

confidence: 99%

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Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

2023

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“…Sheridan and colleagues reported a 27% decrease in mean ED length of stay and an odds ratio of 0.3 for admission or transfer of youth to inpatient psychiatry after increasing pediatric social work and child psychiatry availability to the ED through a liaison program [36]. Holder and colleagues showed a similar impact without a change in cost by increasing pediatric psychiatry time and training of social work for the ED [37]. None of these studies evaluated the impact of specialized mental health teams on ED return visits.…”

Section: Discussionmentioning

confidence: 99%

Reducing length of stay and return visits for emergency department pediatric mental health presentations

et al. 2020

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Background Variability in expertise and risk tolerance among emergency departments (ED) clinicians, when assessing and managing pediatric mental health presentations, leads to increased resource utilization. HEARTSMAP is a validated electronic tool that supports ED clinicians in psychosocial assessments and disposition decision making. Methods We used interrupted time series analysis (September 2016-December 2019) and multivariable regressions to measure the impact of integrating HEARTSMAP into ED practice on pediatric mental health presentations length of stay and return visits, at two pediatric EDs. The intervention site used HEARTSMAP trained ED clinicians to assess and manage mental health presentations, and reported bi-weekly ED median length of stay and 30 days-return visits for 15 months and a year, during passive and active implementation of HEARTSMAP, respectively. The control site used psychiatric nurses to assess and manage patients and was only exposed to passive implementation. Results HEARTSMAP average uptake was on average 47.4% (range 23.8-74.6%) during active implementation at the intervention site, while the control site showed no uptake throughout the study period. Incremental HEARSTMAP (each percent increase) use was associated with a reduction of 1.8 min (95% CI 0.8-2.9 in ED length of stay and 0.3% (95% CI 0.2-0.5 in 30-day return visit rate. This translates to an adjusted average reduction of 85.3 min in ED length of stay and 15.2% in 30-day return visits for youth with mental health presentations. Conclusion Use of HEARTSMAP in the ED can decrease length of stay and return visits for emergency pediatric mental health visits, in a fixed-resource setting.

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Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

Otis

Barber

Amet

et al. 2022

Eur Child Adolesc Psychiatry

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Mental illness heightens risk of medical emergencies, emergency hospitalisation, and readmissions. Innovations for integrated medical–psychiatric care within paediatric emergency settings may help adolescents with acute mental disorders to get well quicker and stay well enough to remain out of hospital. We assessed models of integrated acute care for adolescents experiencing medical emergencies related to mental illness (MHR). We conducted a systematic review by searching MEDLINE, PsychINFO, Embase, and Web of Science for quantitative studies within paediatric emergency medicine, internationally. We included populations aged 8–25 years. Our outcomes were length of hospital stay (LOS), emergency hospital admissions, and rehospitalisation. Limits were imposed on dates: 1990 to June 2021. We present a narrative synthesis. This study is registered on PROSPERO: 254,359. 1667 studies were screened, 22 met eligibility, comprising 39,346 patients. Emergency triage innovations reduced admissions between 4 and 16%, including multidisciplinary staffing and training for psychiatric assessment (F(3,42) = 4.6, P < 0.05, N = 682), and telepsychiatry consultations (aOR = 0.41, 95% CI 0.28–0.58; P < 0.001, N = 597). Psychological therapies delivered in emergency departments reduced admissions 8–40%, including psychoeducation (aOR = 0.35, 95% CI 0.17–0.71, P < 0.01, N = 212), risk-reduction counselling for suicide prevention (OR = 2.78, 95% CI 0.55–14.10, N = 348), and telephone follow-up (OR = 0.45, 95% CI 0.33–0.60, P < 0.001, N = 980). Innovations on acute wards reduced readmissions, including guided meal supervision for eating disorders (P = 0.27), therapeutic skills for anxiety disorders, and a dedicated psychiatric crisis unit (22.2 vs 8.5% (P = 0.008). Integrated pathway innovations reduced readmissions between 8 and 37% including family-based therapy (FBT) for eating disorders (X2(1,326) = 8.40, P = 0.004, N = 326), and risk-targeted telephone follow-up or outpatients for all mental disorders (29.5 vs. 5%, P = 0.03, N = 1316). Studies occurred in the USA, Canada, or Australia. Integrated care pathways to psychiatric consultations, psychological therapies, and multidisciplinary follow-up within emergency paediatric services prevented lengthy and repeat hospitalisation for MHR emergencies. Only six of 22 studies adjusted for illness severity and clinical history between before- and after-intervention cohorts and only one reported socio-demographic intervention effects.

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The Impact of Mental Health Services in a Pediatric Emergency Department

Abstract: Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.

Cited by 18 publications

References 13 publications

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature

Reducing length of stay and return visits for emergency department pediatric mental health presentations

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review

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