High Utilizers of Psychiatric Emergency Services

Pasic, Jagoda; Russo, Joan; Roy‐Byrne, Peter

doi:10.1176/appi.ps.56.6.678

Cited by 148 publications

(158 citation statements)

References 14 publications

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“…However, these frequent attenders accounted for a substantial proportion of such attendances. These findings are similar to those of Pasic et al 5 We also found that frequent attenders had longer psychiatric histories, higher rates of schizophrenia, and were more likely to be prescribed antipsychotics, but had equal gender distribution as compared with single attenders. Chaput & Lebel 6 reported similar findings in their study of similar patient population.…”

Section: Discussionsupporting

confidence: 91%

Patients repeatedly attending accident and emergency departments seeking psychiatric care

2011

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Attendance at accident and emergency (A&E) departments by patients seeking psychiatric care is quite common as A&E departments usually provide crisis intervention as well as serve as an entry point for hospital admission. 1,2 However, some patients repeatedly attend A&E seeking assessment and psychiatric care. These patients may have unmet mental health needs that require more service input. Identifying the clinical characteristics of this patient group and targeting them with more suitable care strategies may reduce such frequent visits to the A&E department.Individuals who frequently attend A&E for psychiatric care have been characterised by other studies 3,4 as being younger males, of Black and minority ethnic background, unmarried, unemployed, and being more likely to have diagnoses of personality disorders and substance misuse. The aim of our study was to identify the clinical characteristics of patients who frequently attend for emergency psychiatric assessment and treatment at the A&E department of the University College Hospital in Galway, Ireland. Emergency psychiatric care at the hospital is shared between a psychiatric emergency liaison team and the out-of-hour duty psychiatric doctors. Ongoing care is provided in the community or acute psychiatric unit by various multidisciplinary teams. We identified patients who received emergency psychiatric care in the A&E department three or more times in a 6-month period and compared their demographic and clinical characteristics with those who received such care only once in the same period. We also examined the relationships between frequent A&E attendance for psychiatric care and hospital admission. MethodAll patients who presented to the A&E department seeking emergency psychiatric care from 1 July to 31 December 2007 were identified. The number of times each patient had attended over that period was tabulated and those who attended frequently were identified.Frequent attenders were defined as those patients who presented for psychiatric care three or more times, whereas single attenders accessed psychiatric care only once within this 6-month period. The threshold of three visits was selected as being likely to represent a subgroup of patients with higher than average visiting profile. Three or more visits were in excess of the 95th percentile for attendances to the A&E department for psychiatric care.Each frequent attender was compared with three randomly selected single attenders matched by age (5-year age bands) and gender. Random selection of the single attenders was based on computer-generated random numbers. In all, 26 frequent attenders were identified; however, data were available for only 24 of them (92.3%). These were then matched with 72 single attenders. The psychiatric records of the 96 individuals were then examined. The information collected for each patient included: Aims and method This study was conducted to ascertain the clinical characteristics of patients who repeatedly attend accident and emergency (A&E) department seeking psychiatric ...

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Section: Discussionsupporting

confidence: 91%

Patients repeatedly attending accident and emergency departments seeking psychiatric care

2011

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“…3 These people access mental health services younger and more frequently than people with psychiatric disorders but no DD 4,5 and are frequent users of EDs. 6 It has been suggested that ED visits by people with psychiatric disorders with DD occur, in part, because other resources are inadequate 7,8 and thus serve as a barometer of the adequacy of primary and specialty outpatient care. A recent study found that lack of primary care predicted ED use in a sample of adults with DD experiencing psychiatric crisis, when adjusting for age, sex, residential setting, and disability severity.…”

Section: Abbreviationsmentioning

confidence: 99%

Emergency Department Visits and Use of Outpatient Physician Services by Adults with Developmental Disability and Psychiatric Disorder

et al. 2012

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Objective:To compare the emergency department (ED), primary, and psychiatric care visit rates associated with the presence and absence of a developmental disability (DD) and a mental illness.Method: This is a population-based study comparing Ontario adults, with and without DDs and mental illnesses, in terms of rates of primary, psychiatric, and ED care, from April 2007 to March 2009. Results:In Ontario, 45% of adults with a DD received a psychiatric diagnosis during a 2-year period, and 26% of those with a psychiatric diagnosis were classified as having a serious mental illness (SMI), compared with 8% of those with a psychiatric diagnosis but no DD. People with DDs had an increased likelihood of psychiatric and ED visits. Patients with SMIs and DDs had the highest rates of such visits. Conclusions:People with more severe impairments had the greatest likelihood of ED visits, despite access to outpatient services, suggesting that outpatient care (primary and psychiatric), as currently delivered, may not be adequate to meet their complex needs. Conclusions : Les personnes souffrant de déficiences plus graves avaient la plus grande probabilité de visites au SU, malgré l'accès à des services ambulatoires, ce qui suggère que les soins ambulatoires (de première ligne et psychiatriques), tels qu'ils sont dispensés actuellement, ne sont peut-être pas adéquats pour répondre à leurs besoins complexes.

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“…49 On the other hand, PESs are the reference units where non-hospital services are insufficient or inexistent, 50 with a significant association existing between problems in the functioning of the outpatient mental health network and the increased number of hospitalizations and re-hospitalizations 51 and the number of visits to PESs. 52 Since PESs work 24 hours a day and usually offer free access, it is natural that unassisted patients and their relatives overload these facilities, which in turn have to deal with the exceeding demand of inefficient outpatient services. 53 Factors that are intrinsically related to the functioning of outpatient services, such as restricted multiprofessional assistance, 54 limited therapeutic proposals, 55 vacancy shortage, 56 medication availability issues, and overload due to demands related to the justice system 57 imply difficulties for the stabilization of patients in acute episodes.…”

Section: Psychiatric Emergency and Outpatient Servicesmentioning

confidence: 99%

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

Barros

Teng

Mari

2010

Rev. Bras. Psiquiatr.

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Objective: To review the literature concerning the role and the inclusion of psychiatric emergency services in mental health networks. Method: We performed a search in online databases (PubMed and SciELO) for empirical articles and reviews about psychiatric emergency services and networks of mental health services. Results: Psychiatric emergency services are a crucial part of well-structured mental health networks, both due to their role in the management of emergencies proper and to their function in the regulation of the network they belong to. Emergency psychiatric services are related to all inpatient and outpatient services, which enables them to organize the flow of admissions and to prevent the overload of the mental health network. The functions of emergency psychiatric services are broad and go beyond the simple referral for hospitalization, encompassing the clinical stabilization of acute cases and the provision of psychosocial support. In Brazil, these functions were expanded after the mental health reform and the overload of the mental health network resulting from the difficulties and limitations of inpatient and outpatient services. Conclusion: Emergency psychiatric services must be valued and expanded; especially those located in general hospitals. It is suggested that investment in psychiatric emergency services be a priority in Brazilian public health policies to improve mental health care. Descriptors

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High Utilizers of Psychiatric Emergency Services

Cited by 148 publications

References 14 publications

Patients repeatedly attending accident and emergency departments seeking psychiatric care

Patients repeatedly attending accident and emergency departments seeking psychiatric care

Emergency Department Visits and Use of Outpatient Physician Services by Adults with Developmental Disability and Psychiatric Disorder

Serviços de emergência psiquiátrica e suas relações com a rede de saúde mental Brasileira

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