A Psychiatric Emergency Clinic: A Study of Attendances Over Six Months

Abstract

Two thousand three hundred and ninety consecutive visits to a walk-in psychiatric emergency service were studied to examine issues relevant to service provision. Only a third of patients were from the catchment area. Psychotic patients and those admitted or kept overnight (guests) were more frequent after hours and among non-medical referrals, especially family and police referrals; but suicidal patients often came from other hospitals. At index visit a third of patients were offered follow-up, but attendance was poor. Factors influencing attendance were examined. Keeping overnight avoided unnecessary admissions. There was little evidence that patients abused the service. The findings suggest that a psychiatric emergency service should be available to all referrals 24 hours a day.

Factors Associated With Involuntary Return to a Psychiatric Emergency Service Within 12 Months

“…As many as one-third of the patients admitted to a psychiatric emergency service are likely to return within the year. This proportion represents an increase from about 10. percent in the early 1970s and approximates the percentage of repeat users noted in the mid-1980s (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). If the use of inpatient psychiatric care is to be restricted under the auspices of managed care, it is crucial to better understand how specific factors associated with the patient's experience at the initial evaluation in the psychiatric emergency service and with interventions after the emergency visit may predict future involuntary returns to the emergency service.…”

The nature of out of hours admissions to a general psychiatric hospital

“…This pattern has already been recog nised in studies of emergency clinics (Lim, 1983) and may in part reflect licencing hours (Mendelson, 1987). Police referrals are also more likely "out of hours".…”

“…However, they also report a high percentage of chronic alcohol problems and re-referrals (Lim, 1983;Blaney & West, 1987;Kehoe & Newton, 1990).…”

Triage in emergency psychiatry

“…Various approaches have been studied in the provision of emergency services (Taylor & Lawrie, 1996;Gordon & Hamilton, 1997) including`walk-in' clinics in London and Edinburgh (Lim, 1983;Kehoe & Newton, 1990).…”