Emergency Room on Weekends: The Only Game in Town

Soskis, Carole W.

doi:10.1093/hsw/5.3.37

Cited by 18 publications

(9 citation statements)

References 3 publications

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“…2,4 A nationwide decrease in mental health services capacity 5 has resulted in an increased burden on the emergency department (ED) to handle mental health crises. 6,7 Mental healthYrelated visits in children have almost doubled in US EDs from 1993 to 1998, with an estimated 327 visits per 10,000 people annually. 8Y10 This increase is out of proportion to the increase in visits related to other chronic diseases.…”

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confidence: 99%

Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

Grupp‐Phelan¹,

Mahajan²,

Foltin³

et al. 2009

Pediatric Emergency Care

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Objective: To describe the patterns of referral and use of resources for patients with psychiatric-related visits presenting to pediatric emergency departments (EDs) in a pediatric research network. Methods:We conducted a retrospective chart review of a random sample of patients (approximately 10 charts per month per site) who presented with psychiatric-related visits in 2002 to 4 pediatric EDs in the Pediatric Emergency Care Applied Research Network. Emergency department resource use variables evaluated included the use of consultation services, restraints, and laboratory tests as well as ED length of stay.Results: We reviewed 462 patient visits with a psychiatric-related ED diagnosis. Mean (SD) age was 12.8 (3.7) years, 52% were male, and 49% were African American. The most common chief complaints were suicidality (47%), aggression/agitation (42%), and anxiety/depression (27%), alone or in combination. Ninety percent of patients (range across sites, 83%Y94%) had a mental health consult in the ED, 5% were restrained (range, 3%Y9%), and 35% had a laboratory test performed (range, 15%Y63%). Mean (SD) ED length of stay was 5.1 (5.4) hours, and 52% were admitted (93% to a psychiatric bed, including transfers to separate psychiatric facilities). Conclusions:Children with psychiatric-related visits seem to require substantial ED resources. Interventions are needed to reduce the burden on the ED by increasing the linkage to mental health services, particularly for suicidal youths.

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confidence: 99%

Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

Grupp‐Phelan¹,

Mahajan²,

Foltin³

et al. 2009

Pediatric Emergency Care

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“…[1][2][3] These units generally manage patients discharged from special hospitals (hospitals which treat psychiatric patients in high security because of their potential risk to others) or those transferred from prisons and courts. There is a wide variation between medium secure units across the UK, for example in the level of physical security provided.…”

Section: Original Papersmentioning

confidence: 99%

“…Accident and emergency (A&E) departments have aptly been described as 'the only game in town' outside normal working hours. 2 This is where young people in a crisis situation take themselves or are taken by others, and their numbers are increasing even though professional help is not always sought. 3,4 Often help is initially offered by paediatric nurses and doctors, who then liaise with child and adolescent psychiatrists.…”

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confidence: 99%

Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning

Hillen

Szaniecki

2010

Psychiatrist

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Paediatric psychiatric emergencies typically comprise self-harm, acute manifestations of mental illness and severe behavioural disturbances including violence. 1 Frequently, young people in psychosocial crisis situations also present to hospital. Accident and emergency (A&E) departments have aptly been described as 'the only game in town' outside normal working hours.2 This is where young people in a crisis situation take themselves or are taken by others, and their numbers are increasing even though professional help is not always sought. 3,4 Often help is initially offered by paediatric nurses and doctors, who then liaise with child and adolescent psychiatrists. Guidance regarding the management of paediatric psychiatric emergencies has mainly been published with regard to self-harm; and the need for a comprehensive specialist psychosocial assessment has been emphasised in the UK since 1998. 6,7 Although improved and timely access to specialist services is a UK government target, currently only a quarter of child and adolescent mental health services (CAMHS) provide emergency cover outside normal working hours. 8,9 Many CAMHS still have to establish emergency duty services. A good understanding of when demand is likely to be at its greatest will help with service planning. So far, research into cyclic variations in psychiatric emergencies has mainly focused on adults and self-harm. How often and when individuals present to psychiatric emergency services is influenced by the organisation of the wider support networks, referral pathways and admission policies. Considerable variation in these service-dependent factors has been reported. [10][11][12] However, fluctuations in emergency presentations have also been linked to service-independent factors such as diurnal, seasonal and meteorological variations. For example, more individuals present in the evening and at weekends, in spring, and on days with nice weather. [13][14][15][16] This study set out to investigate cyclic variations in demand for paediatric psychiatric provision outside normal working hours in a large and diverse urban population. We wanted to find out whether service-dependent factors such as the availability of liaison daytime cover, the introduction of A&E waiting targets or high A&E workload were associated with demand for out-of-hours provision. We also investigated whether service-independent factors such as school holidays, the season and the weather related to demand. ORIGINAL PAPERSHillen & Szaniecki Out-of-hours services in child and adolescent psychiatry The Psychiatrist (2010) Aims and method We examined peaks and troughs in demand for out-of-hours consultations and assessments in child and adolescent psychiatry and whether these have implications for service development. All out-of-hours referrals in three teaching hospitals providing services to a large and diverse inner-city population were prospectively registered from 1 January 2002 to 31 December 2005.Results In total, 323 individuals under 18 years were referred; 21.6 (95% CI 1...

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“…Many authors (Dobson and Hansen 1976;Forster 1998;Herbert and Levin 1996; Ad Hoc Committee on Advocacy, NASW 1969; Sigal et al 2000;Soskis 1980) noted the inherent conflict of interest in being a representative of the same organization about which the patient is complaining. As more than one client has put it: ''I may as well not bother to talk to you because you are paid by the mental health center.''…”

Section: Conflicts In the Advocate's Rolementioning

confidence: 99%

Clinical Social Worker as Patient Advocate in a Community Mental Health Center

Faust

2007

Clin Soc Work J

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As a profession, social work has always advocated for clients. Yet clinical social work settings often ignore this important aspect of practice. For mental health services in public agencies, patient advocacy is a particularly vital element because these systems are not always responsive to the individual client. The clinical social worker, trained in advocacy, systemic intervention, and psychotherapy, is the professional most qualified to fill this role. The author summarizes the history of advocacy, provides a conceptual framework for the clinical social work advocate, and provides examples from 20 years of experience as a patient advocate in community mental health.

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Emergency Room on Weekends: The Only Game in Town

Cited by 18 publications

References 3 publications

Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

Referral and Resource Use Patterns for Psychiatric-Related Visits to Pediatric Emergency Departments

Cyclic variations in demand for out-of-hours services in child and adolescent psychiatry: implications for service planning

Clinical Social Worker as Patient Advocate in a Community Mental Health Center

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