Impact of Closure of Mental Health Center: Emergency Department Utilization and Length of Stay among Patients with Severe Mental Illness

Little, David; Clasen, Mark E.; Hendricks, J; Walker, Issa Anthony

doi:10.1353/hpu.2011.0057

Cited by 14 publications

(11 citation statements)

References 5 publications

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“…Psychiatric patients represent a major challenge for EDs, 1 mainly because of their increased volume, 2,8,45,46 long ED LOS, 2,11,47,48 and high admission rates. 8,10 In our study, 97% of our patient population was admitted from the ED, with an average LOS of 37 and 76 hours for the JGH Waiting for a specific treatment 3 6.0…”

Section: 44mentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions:Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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Section: 44mentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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“… 2 , 8 – 11 ED visits increase when mental health services are unavailable or uncoordinated. 12 – 14 Nationally, frequent ED users for all diagnoses account for 3–8% of all ED patients and 21–28% of all ED visits. 15 – 17 High ED utilization is often seen as a marker of unmet healthcare needs as well as an opportunity to decrease healthcare costs and improve resource utilization.…”

Section: Introductionmentioning

confidence: 99%

Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

Moulin

Evans

Xing

et al. 2018

WestJEM

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IntroductionFrequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs.MethodsThis retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder.ResultsIn the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92–4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27–1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20–3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94–3.25]) were also more likely to be frequent users compared with those with private insurance coverage.ConclusionPatients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.

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“…However, psychiatric patients appear to contribute disproportionately to ED overcrowding. Psychiatry patients experience longer treatment times in the ED compared to nonpsychiatric patients regardless of acuity level [2][3][4][5][6], despite the fact that deleterious effects of extended lengths of stay (LOSs) have been well documented for both psychiatric and nonpsychiatric patients [7][8][9][10]. Thus, ED LOS for psychiatric patients is an important concern.…”

Section: Introductionmentioning

confidence: 99%

“…The causes of longer LOSs for psychiatric patients have been ascribed to several causes often not under the control of ED physician or staff, including patients presenting with suicidal or homicidal ideation, inpatient bed availability, the organization of the psychiatry service/willingness to conduct regular rounds, and day of the week [5,6,[11][12][13][14]. Only 2 factors that are reasonably within the control of typical ED clinicians, including the length of time before specialist evaluation is requested and restraint use, have been associated with longer LOSs [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

Wilson¹,

Brennan²,

Modesti³

et al. 2015

The American Journal of Emergency Medicine

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Background: Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS. Methods: A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS. Results: Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends. Conclusions: Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.

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Impact of Closure of Mental Health Center: Emergency Department Utilization and Length of Stay among Patients with Severe Mental Illness

Cited by 14 publications

References 5 publications

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization

Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use

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