Lengths of stay for involuntarily-held psychiatric patients in the emergency department are affected both by patient characteristics and medication use (original) (raw)
Related papers
Length of Stay in a Community Psychiatric Emergency Room: An Analysis of Contributing Factors
International Journal of Innovative Research in Medical Science
Background: The length of patients’ stay in the emergency room is a key measure of service delivery and a marker to measure the quality of care. Studies have shown that patients with psychiatric and substance use disorders have a prolonged length of stay in the emergency room compared to medical and surgical patients. Various factors have been found to contribute to this disparity. Method: This is a retrospective case by case review of four hundred and ninety-three consecutive patients who presented to a community psychiatric emergency. Results: Our results show a length of stay ranging between 1.21 – 33.48 hours. The mean length of stay of 8.72 hours and the median was 7.41 hours. Furthermore, the utilization of emergency medication and age above 44 have a significant influence on patients’ length of stay in the psychiatric emergency room (p<0.05). Conclusion: The length of stay in the psychiatric emergency room deserves more study in literature as it remains a metric for servic...
Predictors of the length of stay in a psychiatric emergency care centre
Australasian Psychiatry, 2013
Objective: This paper aims to ascertain predictors of the length of stay in a Psychiatric Emergency Care Centre (PECC). Methods: Demographic and clinical characteristics were recorded retrospectively via file audit in 477 patients who were admitted to a PECC within a six-month period. Associations between these variables and length of stay were analysed using logistic regression. Results: Length of stay in the PECC was predicted by medical complications arising in the PECC, absconding behaviour, diagnosis of depression and being brought in by family members. Aggression within the PECC and previous contact with mental health services predicted a shorter stay. Conclusions: Length of stay in the PECC is predicted by a number of variables that are different from those that predict length of stay in an acute psychiatric unit. A comprehensive assessment of these variables prior to admission may decrease the length of stay in the PECC and improve efficiency of acute psychiatric services.
Revista Brasileira de Psiquiatria, 2009
OBJECTIVE: Characterize and compare acute psychiatric admissions to the psychiatric wards of a general hospital (22 beds), a psychiatric hospital (80) and of an emergency psychiatry unit (6). METHOD: Survey of the ratios and shares of the demographic, diagnostic and hospitalization variables involved in all acute admissions registered in a catchment area in Brazil between 1998 and 2004. RESULTS: From the 11,208 admissions, 47.8% of the patients were admitted to a psychiatric hospital and 14.1% to a general hospital. The emergency psychiatry unit accounted for 38.1% of all admissions during the period, with a higher variability in occupancy rate and bed turnover during the years. Around 80% of the hospital stays lasted less than 20 days and in almost half of these cases, patients were discharged in 2 days. Although the total number of admissions remained stable during the years, in 2004, a 30% increase was seen compared to 2003. In 2004, bed turnover and occupancy rate at the emergen...
Risk Management and Healthcare Policy
To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term "long stay" indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/ or health-care system organization appear relevant factors in prolonging stays. Patients and Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5 th percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson's chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models. Results: The longest hospitalizations were significantly related to the diagnosis of "schizophrenia and other psychosis" (Pearson Chi 2 =17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi 2 =29; p=0.000), compulsory treatment (Pearson Chi 2 =8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi 2 =12.91; p=0.007), poli-therapy (Pearson Chi 2 =6.40; p=0.041), complex psychiatric activities (Pearson Chi 2 =12.26; p=0.002) and rehabilitative programs (Pearson Chi 2 =37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi 2 =29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model. Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.
International Journal of Emergency Medicine, 2020
Objectives: To determine the role of previous psychiatric disorders including substance use disorders on emergency department (ED) patients on involuntary holds and compare presentations, treatment, and outcomes based on cause. Methods: We conducted a retrospective study of patients ≥ 18 years old on involuntary holds in the ED of a tertiary care center from January 1, 2013, to November 30, 2015. Demographic and clinical information were collected. Those with and without prior psychiatric disorder including substance use disorder were compared. Results: We identified 251 patients of which 129 (51.4%) had a psychiatric disorder, 23 (9.2%) had a substance use disorder, and 86 (34.3%) had both. Thirteen patients (5.2%) had no psychiatric disorder or substance use disorder and the majority 10 (76.9%) were on involuntary holds due to suicidal threats related to pain or another medical problem. Patients without a psychiatric or substance use disorder were older (55 years [17.8] vs 42 [19]; P = 0.01), more likely to be married (10 [76.9%] vs 64 [26.9%]; P < 0.001), and had more medical comorbidities (10 [76.9%] vs 114 [47.9%]; P = 0.049) compared with those without a psychiatric or substance use disorder. Conclusion: Patients on involuntary holds most commonly have pre-existing psychiatric disorder including substance use disorder. Patients on involuntary holds without history of psychiatric disorder often have severe pain or other active medical conditions which may contribute to suicidal thoughts. Addressing these underlying medical issues may be crucial in preventing further psychiatric decompensation.
Predictors of involuntary hospitalizations to acute psychiatry
2013
a b s t r a c t a r t i c l e i n f o Available online xxxx Introduction: There is little knowledge of predictors for involuntary hospitalizations in acute psychiatric units. Method: The Multi-center study of Acute Psychiatry included all cases of acute consecutive psychiatric admissions in twenty acute psychiatric units in Norway, representing about 75% of the acute psychiatric units during 2005-2006. Data included admission process, rating of Global Assessment of Functioning and Health of the Nation Outcome Scales.
A retrospective analysis of determinants of involuntary psychiatric in-patient treatment
BMC Psychiatry, 2019
Background: The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. Methods: We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID). Results: Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered. Conclusions: We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric inpatient treatment. This may include efforts to establish crisis resolution teams to improve outpatient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999), 2017
There have been significant reductions in numbers of psychiatric beds and length of stay (LOS) worldwide, making LOS in psychiatric beds an interesting outcome. The objective of this study was to find factors measurable on admission that would predict LOS in the acute psychiatric setting. This was a prospective, observational study. Overall, 385 subjects were included. The median LOS was 25 days. In the final model, six variables explained 14.6% of the variation in LOS: not having own income, psychiatric admissions in the preceding 2 years, high Clinical Global Impression and Brief Psychiatric Rating Scale scores, diagnosis of schizophrenia, and history of attempted suicide. All variables were associated with longer LOS, apart from history of attempted suicide. Identifying patients who will need to stay longer in psychiatric beds remains a challenge. Improving knowledge about determinants of LOS could lead to improvements in the quality of care in hospital psychiatry.
Annals of Emergency Medicine
Study objective: Patients with acute psychiatric emergencies who receive an involuntary hold often spend hours in the emergency department (ED) because of a deficit in inpatient psychiatric beds. One solution to address the lack of prompt psychiatric evaluation in the ED has been to establish regional stand-alone psychiatric emergency services. However, patients receiving involuntary holds still need to be screened and evaluated to ensure that their behavior is not caused by an underlying and life-threatening nonpsychiatric illness. Although traditional regional emergency medical services (EMS) systems depend on the medical ED for this function, a field-screening protocol can allow EMS to directly transport a substantial portion of patients to a stand-alone psychiatric emergency service. The purpose of this investigation is to describe overall EMS use for patients receiving involuntary holds, compare patients receiving involuntary holds with all EMS patients, and evaluate the safety of field medical clearance of an established field-screening protocol in Alameda County, CA.
The Impact of Psychiatric Patient Boarding in Emergency Departments
Emergency Medicine International, 2012
Objectives. Studies have demonstrated the adverse effects of emergency department (ED) boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits) from January 2007-2008. The main outcomes were ED length of stay (LOS) and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1%) requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years), with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039-1140) versus 340 min, CI (304-375); P < 0.001) when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198) compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients) per psychiatric patient, and decreasing financial revenue.