10-Year Trends of Emergency Department Visits, Wait Time, and Length of Stay among Adults with Mental Health and Substance use Disorders in the United States

Nam, Eunji; Lee, Eunkyung; Kim, Hyemee

doi:10.1007/s11126-021-09894-y

Cited by 9 publications

(9 citation statements)

References 37 publications

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“… 3–8 In the USA, ED visits by adults with MSUD increased by over 30% between 2006 and 2015, primarily due to alcohol use disorder, followed by mood and anxiety disorders. 7 These findings extend earlier observation of increasing trends between 1992 and 2001. 8 Similarly, in Australia, MSUD ED visits increased between 2004/2005 and 2016/2017, driven largely by psychoactive substance use, followed by anxiety and mood disorders.…”

Section: Introductionsupporting

confidence: 88%

“…As expected, based on international literature, rates of ED visits for MSUD are substantial and growing, with roughly 1.5% of British Columbians ages 15 and older visiting an ED for MSUD in 2017/2018. The upward trend in ED visits largely reflects the impact of substance use and anxiety disorders as has been observed in other studies 3 7 9. High rates of comorbidity between substance use and anxiety disorders within clinical and population samples are well established 36.…”

Section: Discussionsupporting

confidence: 55%

“…Internationally, literature points to increasing ED visits across varied populations and contexts 3–8. In the USA, ED visits by adults with MSUD increased by over 30% between 2006 and 2015, primarily due to alcohol use disorder, followed by mood and anxiety disorders 7.…”

Section: Introductionmentioning

confidence: 99%

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Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

et al. 2022

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ObjectivesInformation on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.DesignPopulation-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.SettingBC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.PopulationAll people age >15 with MSUD ED visits during the study period.MeasuresAll claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described.ResultsA total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care.ConclusionsMSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.

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Section: Introductionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 55%

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Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

et al. 2022

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“…Reducing time spent in the emergency department by using short-stay crisis units as part of the crisis care pathway 23,24,37,22 could help to improve the flow of patients through the emergency department, 20,21 and so these findings are potentially important to general hospitals struggling with emergency department capacity and planning. 2,3 We also found that the likelihood of an in-patient admission for people in crisis was reduced following a stay on a crisis unit (compared with patients not accessing crisis units). 24,37,22,39 It is possible that crisis units are functioning to delay in-patient admission, 38 although in one study the total time spent in crisis and acute care following the index crisis presentation was reduced.…”

Section: Discussionmentioning

confidence: 67%

“…There is an international crisis in acute mental healthcare. 1 In the USA, the number of emergency department visits for patients with mental health issues increased by a third between 2006 and 2015, 2 resulting in long waiting times. 3 A similar picture has emerged in Canada, 4 the UK 5 and Australia.…”

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confidence: 99%

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis

et al. 2022

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Background Internationally, an increasing proportion of emergency department visits are mental health related. Concurrently, psychiatric wards are often occupied above capacity. Healthcare providers have introduced short-stay, hospital-based crisis units offering a therapeutic space for stabilisation, assessment and appropriate referral. Research lags behind roll-out, and a review of the evidence is urgently needed to inform policy and further introduction of similar units. Aims This systematic review aims to evaluate the effectiveness of short-stay, hospital-based mental health crisis units. Method We searched EMBASE, Medline, CINAHL and PsycINFO up to March 2021. All designs incorporating a control or comparison group were eligible for inclusion, and all effect estimates with a comparison group were extracted and combined meta-analytically where appropriate. We assessed study risk of bias with Risk of Bias in Non-Randomized Studies – of Interventions and Risk of Bias in Randomized Trials. Results Data from twelve studies across six countries (Australia, Belgium, Canada, The Netherlands, UK and USA) and 67 505 participants were included. Data indicated that units delivered benefits on many outcomes. Units could reduce psychiatric holds (42% after intervention compared with 49.8% before intervention; difference = 7.8%; P < 0.0001) and increase out-patient follow-up care (χ2 = 37.42, d.f. = 1; P < 0.001). Meta-analysis indicated a significant reduction in length of emergency department stay (by 164.24 min; 95% CI −261.24 to −67.23 min; P < 0.001) and number of in-patient admissions (odds ratio 0.55, 95% CI 0.43–0.68; P < 0.001). Conclusions Short-stay mental health crisis units are effective for reducing emergency department wait times and in-patient admissions. Further research should investigate the impact of units on patient experience, and clinical and social outcomes.

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Substance Use Disorder Program Availability in Safety-Net and Non–Safety-Net Hospitals in the US

Chang,

Franz,

Pagán

et al. 2023

JAMA Netw Open

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ImportanceSafety-net hospitals (SNHs) are ideal sites to deliver addiction treatment to patients with substance use disorders (SUDs), but the availability of these services within SNHs nationwide remains unknown.ObjectiveTo examine differences in the delivery of different SUD programs in SNHs vs non-SNHs across the US and to determine whether these differences are increased in certain types of SNHs depending on ownership.Design, Setting, and ParticipantsThis cross-sectional analysis used data from the 2021 American Hospital Association Annual Survey of Hospitals to examine the associations of safety-net status and ownership with the availability of SUD services at acute care hospitals in the US. Data analysis was performed from January to March 2022.Main Outcomes and MeasuresThis study used 2 survey questions from the American Hospital Association survey to determine the delivery of 5 hospital-based SUD services: screening, consultation, inpatient treatment services, outpatient treatment services, and medications for opioid use disorder (MOUD).ResultsA total of 2846 hospitals were included: 409 were SNHs and 2437 were non-SNHs. The lowest proportion of hospitals reported offering inpatient treatment services (791 hospitals [27%]), followed by MOUD (1055 hospitals [37%]), and outpatient treatment services (1087 hospitals [38%]). The majority of hospitals reported offering consultation (1704 hospitals [60%]) and screening (2240 hospitals [79%]). In multivariable models, SNHs were significantly less likely to offer SUD services across all 5 categories of services (screening odds ratio [OR], 0.62 [95% CI, 0.48-0.76]; consultation OR, 0.62 [95% CI, 0.47-0.83]; inpatient services OR, 0.73 [95% CI, 0.55-0.97]; outpatient services OR, 0.76 [95% CI, 0.59-0.99]; MOUD OR, 0.6 [95% CI, 0.46-0.78]). With the exception of MOUD, public or for-profit SNHs did not differ significantly from their non-SNH counterparts. However, nonprofit SNHs were significantly less likely to offer all 5 SUD services compared with their non-SNH counterparts (screening OR, 0.52 [95% CI, 0.41-0.66]; consultation OR, 0.56 [95% CI, 0.44-0.73]; inpatient services OR, 0.45 [95% CI, 0.33-0.61]; outpatient services OR, 0.58 [95% CI, 0.44-0.76]; MOUD OR, 0.61 [95% CI, 0.46-0.79]).Conclusions and RelevanceIn this cross-sectional study of SNHs and non-SNHs, SNHs had significantly lower odds of offering the full range of SUD services. These findings add to a growing body of research suggesting that SNHs may face additional barriers to offering SUD programs. Further research is needed to understand these barriers and to identify strategies that support the adoption of evidence-based SUD programs in SNH settings.

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10-Year Trends of Emergency Department Visits, Wait Time, and Length of Stay among Adults with Mental Health and Substance use Disorders in the United States

Cited by 9 publications

References 37 publications

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

Emergency department use for mental and substance use disorders: descriptive analysis of population-based, linked administrative data in British Columbia, Canada

Short-stay crisis units for mental health patients on crisis care pathways: systematic review and meta-analysis

Substance Use Disorder Program Availability in Safety-Net and Non–Safety-Net Hospitals in the US

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