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

Wilson, Michael P.; Brennan, Jesse J.; Modesti, Lucia; Deen, James; Anderson, Laura N.; Vilke, Gary M.; Castillo, Edward M.

doi:10.1016/j.ajem.2015.01.017

Cited by 24 publications

(18 citation statements)

References 24 publications

(34 reference statements)

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“…Decreasing LOS is also important to decrease ED crowding and potential adverse events 32. Some authors have noted that psychotropic medication administration may increase LOS for psychiatric patients compared to patients who do not receive medication 33,34. A retrospective study found that use of physical or chemical restraint in patients over 65 years of age was associated with longer LOS by over 12 hours 35.…”

Section: Discussionmentioning

confidence: 99%

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

Shenvi¹,

Wilson²,

Aldai³

et al. 2019

WestJEM

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Introduction Agitation, mental illness, and delirium are common reasons for older adults to seek care in the emergency department (ED). There are significant knowledge gaps in understanding how to best screen older adults for these conditions and how to manage them. In addition, in areas where research has been performed, implementation has been slow. A working group convened to develop a set of high-priority research questions that would advance the understanding of optimal management of older adults with acute behavioral changes in the ED. This manuscript is the product of a breakout session on “Special Populations: Agitation in the Elderly” from the 2016 Coalition on Psychiatric Emergencies’ first Research Consensus Conference on Acute Mental Illness. Methods Participants were identified with expertise in emergency medicine (EM), geriatric EM, and psychiatry. Background literature reviews were performed prior to the in-person meeting in four key areas: delirium; dementia; substance abuse or withdrawal; and mental illness in older adults. Input was solicited from all participants during the meeting, and questions were iteratively focused and revised, voted on, and ranked by importance. Results Fourteen questions were identified by the group with high consensus for their importance related to the care of older adults with agitation in the ED. The questions were grouped into three topic areas: screening and identification; management strategies; and the approach to delirium. Conclusion It is important for emergency physicians to recognize the spectrum of underlying causes of behavioral changes, have the tools to screen older adults for those causes, and employ methods to treat the underlying causes and ameliorate their symptoms. Answers to the identified research questions have great potential to improve the care of older adults presenting with behavioral changes.

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Section: Discussionmentioning

confidence: 99%

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

Shenvi¹,

Wilson²,

Aldai³

et al. 2019

WestJEM

View full text Add to dashboard Cite

show abstract

“…At present, literature regarding emergent psychosis intervention has predominantly focused on management of agitation 12–15. First- or second-generation antipsychotic medication interventions have measured outcomes such as achieving calm behavior16 or decreasing need for additional medications 15,17. These measures neglect the vast spectrum of distressing, patient-level experiences of psychosis such as delusional thought content, sensory hallucinations, and negative affective states.…”

Section: Discussionmentioning

confidence: 99%

A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients

Peltzer-Jones¹,

Nordstrom²,

Currier³

et al. 2019

WestJEM

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Introduction Emergency departments (ED) manage a wide variety of critical medical presentations. Traumatic, neurologic, and cardiac crises are among the most prevalent types of emergencies treated in an ED setting. The high volume of presentations has led to collaborative partnerships in research and process development between experts in emergency medicine (EM) and other disciplines. While psychosis is a medical emergency frequently treated in the ED, there remains a paucity of evidence-based literature highlighting best practices for management of psychotic presentations in the ED. In the absence of collaborative research, development of best practice guidelines cannot begin. A working group convened to develop a set of high-priority research questions to address the knowledge gaps in the care of psychotic patients in the ED. This article is the product of a subgroup considering “Special Populations: Psychotic Spectrum Disorders,” from the 2016 Coalition on Psychiatric Emergencies first Research Consensus Conference on Acute Mental Illness. Methods Participants were identified with expertise in psychosis from EM, emergency psychiatry, emergency psychology, clinical research, governmental agencies, and patient advocacy groups. Background literature reviews were performed prior to the in-person meeting. A nominal group technique was employed to develop group consensus on the highest priority research gaps. Following the nominal group technique, input was solicited from all participants during the meeting, questions were iteratively focused and revised, voted on, and then ranked by importance. Results The group developed 28 separate questions. After clarification and voting, the group identified six high-priority research areas. These questions signify the perceived gaps in psychosis research in emergency settings. Questions were further grouped into two topic areas: screening and identification; and intervention and management strategies. Conclusion While psychosis has become a more common presentation in the ED, standardized screening, intervention, and outcome measurement for psychosis has not moved beyond attention to agitation management. As improved outpatient-intervention protocols are developed for treatment of psychosis, it is imperative that parallel protocols are developed for delivery in the ED setting.

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“…Involuntary holds are commonly placed by emergency physicians and are often associated with longer emergency department (ED) length of stay [1,2]. Much of what is known about involuntary holds comes from studies of patients admitted to psychiatric units for exacerbation of their ongoing psychiatric disorder including substance use disorder.…”

Section: Introductionmentioning

confidence: 99%

Are pre-existing psychiatric disorders the only reason for involuntary holds in the emergency department?

et al. 2020

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Objectives:To determine the role of previous psychiatric disorders including substance use disorders on emergency department (ED) patients on involuntary holds and compare presentations, treatment, and outcomes based on cause. Methods: We conducted a retrospective study of patients ≥ 18 years old on involuntary holds in the ED of a tertiary care center from January 1, 2013, to November 30, 2015. Demographic and clinical information were collected. Those with and without prior psychiatric disorder including substance use disorder were compared. Results: We identified 251 patients of which 129 (51.4%) had a psychiatric disorder, 23 (9.2%) had a substance use disorder, and 86 (34.3%) had both. Thirteen patients (5.2%) had no psychiatric disorder or substance use disorder and the majority 10 (76.9%) were on involuntary holds due to suicidal threats related to pain or another medical problem. Patients without a psychiatric or substance use disorder were older (55 years [17.8] vs 42 [19]; P = 0.01), more likely to be married (10 [76.9%] vs 64 [26.9%]; P < 0.001), and had more medical comorbidities (10 [76.9%] vs 114 [47.9%]; P = 0.049) compared with those without a psychiatric or substance use disorder. Conclusion: Patients on involuntary holds most commonly have pre-existing psychiatric disorder including substance use disorder. Patients on involuntary holds without history of psychiatric disorder often have severe pain or other active medical conditions which may contribute to suicidal thoughts. Addressing these underlying medical issues may be crucial in preventing further psychiatric decompensation.

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

Cited by 24 publications

References 24 publications

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

A Research Agenda for the Assessment and Management of Acute Behavioral Changes in Elderly Emergency Department Patients

A Research Agenda for Assessment and Management of Psychosis in Emergency Department Patients

Are pre-existing psychiatric disorders the only reason for involuntary holds in the emergency department?

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