Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review

Gabet, Morgane; Armoon, Bahram; Meng, Xiangfei; Fleury, Marie-Josée

doi:10.1016/j.ajem.2023.09.008

Cited by 7 publications

(2 citation statements)

References 37 publications

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“…A description of the characteristics of each type of suicide or self-harm strategy and their reported effect is provided in Table 3 . Two of the nine articles included an academic medical centre and one general hospital ( 30 , 57 , 59 ). Six of the nine studies did not report the type of participating hospital ( 53 – 55 , 58 , 60 , 61 ).…”

Section: Resultsmentioning

confidence: 99%

“…The desire to improve care for adults presenting to ED with mental illness has prompted better understanding of the characteristics of ED presentations such as deliberate self-harm ( 14 – 16 ), suicidal ideation ( 17 , 18 ), anxiety and depression ( 19 , 20 ), substance use ( 21 ), specific vulnerabilities among the homeless ( 22 , 23 ) or incarcerated adults ( 24 , 25 ), and symptomatology including agitation resulting in restraint ( 26 , 27 ). Similarly, systematic reviews shed light on the strategies employed to improve care for adults presenting to ED with acute mental illness, exploring the effectiveness of case management ( 28 ), various liaison psychiatry models ( 29 ), as well as strategies specifically targeting frequent users ( 30 ), deliberate self-harm ( 31 ), and opioid use disorder ( 32 ). These systematic reviews provide insights into the impact of strategies to improve care delivery in the ED for individual models of care and specific patient presentations, they do not provide a comprehensive synthesis of reported strategies and their impact on system performance, patient outcomes, patient experience, and staff experience.…”

Section: Introductionmentioning

confidence: 99%

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Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Austin,

Cheek,

Richardson

et al. 2024

Front. Psychiatry

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BackgroundCare delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness.MethodWe systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools.ResultsA narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging.ConclusionCare for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Austin,

Cheek,

Richardson

et al. 2024

Front. Psychiatry

View full text Add to dashboard Cite

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Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

Fleury,

Imboua,

Grenier

2024

Community Ment Health J

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Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

Fleury,

Ferland,

Farand

et al. 2024

Int J Mental Health Nurs

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For patients with mental illnesses (MIs), emergency departments (EDs) are often the entry point into the healthcare system, or their only resort for quickly accessing mental health treatment. A better understanding of the various barriers justifying high ED use among patients with MIs may help recommend targeted interventions that better meet their needs. This explorative qualitative study aimed to identify such barriers and the solutions brought forth to reduce ED use based on the perspectives of clinicians and managers working in EDs, other hospital departments or the community sector. Interviews were conducted between April 2021 and February 2022; 86 mental health professionals (22% were nurses) from four large urban ED sites in Quebec (Canada) were interviewed. Barriers were identified in relation to patient profiles, healthcare system and organisational features and professional characteristics. The key barriers that were found to explain high ED use were patients having serious MIs (e.g., psychotic disorders) or social issues (e.g., poverty), lack of coordination and patient referrals between EDs and other health services, insufficient access to mental health and addiction services and inadequacy of care. Very few solutions were implemented to improve care for high ED users. Better deployment of ED interventions in collaboration with outpatient care may be prioritised to reduce high ED use for patients with MIs. Improvements to the referral and transfer processes to outpatient care, particularly through care plans and case management programs, may be implemented to reduce high ED use and improve outpatient care among patients with multiple health and social needs.

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Effectiveness of emergency department based interventions for frequent users with mental health issues: A systematic review

Cited by 7 publications

References 37 publications

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance

Barriers and Facilitators to High Emergency Department Use Among Patients with Mental Disorders: A Qualitative Investigation

Reasons Explaining High Emergency Department Use in Patients With Mental Illnesses: Different Staff Perspectives

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