Access to Outpatient Pediatric Mental Health Care After Emergency Department Discharge

Abstract

Objectives: Pediatric mental health presentations to emergency departments (EDs) have shown dramatic increases nationally. This study aimed to identify the ability of patients discharged with mental health from the ED to establish outpatient care.Methods: This was a cross-sectional study of all mental health patients aged 7 to 19 years who were seen by a child psychiatry consult team in a tertiary care pediatric ED from September 2016 to January 2017. Patients were contacted by phone at least 6 months after discharge. Data obtained included time to follow-up, reasons for delayed follow-up, type of provider seen, and frequency of outpatient visits.Results: Two hundred twenty-eight charts were reviewed and 51 were successfully interviewed. The median age was 14 years and 61% were female. Most patients (61%) reported seeing a psychiatrist or therapist, whereas 19% reported a primary care provider and 19% reporting "other."The majority were able to establish care within 1 month (73%), whereas 9% reported never obtaining outpatient follow-up. Most patients (58%) were able to be seen more than once per month. The most common reason for delayed follow-up was provider availability.Conclusions: This study found that a large number of patients were able to be seen within 1 month of discharge for mental health care. However, almost 10% of patients never established outpatient care, which is concerning and is an area needing further research.

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where

“…These include increasing primary care utilization, transferring care for boarding patients to inpatient teams, increasing the care provided in triage, and creating alternative care sites for seeing patients. [18][19][20][21] Alternative care sites are spaces temporarily converted for health care delivery to provide additional capacity and capability. 22 In the case of the ED, alterative care site refers to a space converted for clinical use outside of the main ED where care is provided by the ED staff.…”

“…While patient volumes and mix do not change abruptly, they eventually reach a threshold that prompts pediatric EDs to innovate clinical operations models in response. These include increasing primary care utilization, transferring care for boarding patients to inpatient teams, increasing the care provided in triage, and creating alternative care sites for seeing patients 18–21 . Alternative care sites are spaces temporarily converted for health care delivery to provide additional capacity and capability 22 .…”

Impact of a Mental Health Screening Process in a Pediatric Emergency Department

“…13 A significant barrier to implementing these models includes the scarcity of certain mental health resources in the ED, the challenge of establishing safe disposition with efficiency, and outpatient mental health management. 2 One study by Sheridan et al 14 reported that although the majority of patients are evaluated by mental health specialists within 1 month of discharge, almost 10% of patients never establish continuing mental health care.…”

Addressing Suicide Risk in Primary Care: Cost Savings Associated with Diverting Patients From Emergency Departments

“…9 Furthermore, providers in the ED report complex barriers to addressing suicidality in the ED setting and generally apply a biomedical model for treating suicidal patients with limited continuity of care. 10,11 In addition to potentially distressing patient and provider experiences, suicide evaluations in a general ED present financial and time burdens to both the patient and the medical center. Estimates of the national cost of suicide in the United States range from 44.7 billion to 93.5 billion US dollars, 12,13 and EDs across the United States report over 500,000 visits with chief complaint of suicidality, although this is not specific to pediatric ED visits.…”