National trends in mental health-related emergency department visits by children and adults, 2009–2015

Santillanes, Genevieve; Axeen, Sarah; Lam, Chun Nok; Menchine, Michael

doi:10.1016/j.ajem.2019.12.035

Cited by 84 publications

(63 citation statements)

References 41 publications

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“…Due to their longer length of stay, mental-health-related visits comprise a disproportionate amount of ED time. For example, in a large cohort of patients in southern California between 2009 and 2015, 8.2% of all ED visits by adults were mental-health-related, but these visits accounted for 11.2% of all ED hours utilized by adults [11]. This disproportionate consumption of ED time likely contributes to overall ED crowding which can contribute to decreased quality of care for other conditions [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Costanza

Mazzola²,

Radomska

et al. 2020

Medicina

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Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST®) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.

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Section: Introductionmentioning

confidence: 99%

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Costanza

Mazzola²,

Radomska

et al. 2020

Medicina

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“…Over the past 2 decades, young people have increasingly sought acute mental health care in emergency departments (EDs). 1,2 In this issue of Pediatrics, Nash et al 3 examine ED length of stay for children with mental health conditions. They draw on 10 years of data from the National Hospital Ambulatory Medical Care Survey (2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) to compare length of stay for visits with and without a mental health diagnosis.…”

mentioning

confidence: 99%

Equity in Emergency Mental Health Care

Krass

Doupnik

2021

Pediatrics

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“…In addition, fair/poor selfrated health and severe or chronic medical conditions, such as diabetes, asthma, and cardiovascular or lung diseases, are associated with frequent ED use [5][6][7]. Substance use (e.g., overdose, injuries) and mental disorders also contribute to ED visits [7,8].…”

Section: Introductionmentioning

confidence: 99%

Predictive model of multiple emergency department visits among adults: analysis of the data from the National Survey of Drug Use and Health (NSDUH)

Bobashev

Warren

2021

BMC Health Serv Res

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Background In this methodological paper, we use a novel, predictive approach to examine how demographics, substance use, mental and other health indicators predict multiple visits (≥3) to emergency departments (ED) within a year. Methods State-of-the-art predictive methods were used to evaluate predictive ability and factors predicting multiple visits to ED within a year and to identify factors that influenced the strength of the prediction. The analysis used public-use datasets from the 2015–2018 National Surveys on Drug Use and Health (NSDUH), which used the same questionnaire on the variables of interest. Analysis focused on adults aged ≥18 years. Several predictive models (regressions, trees, and random forests) were validated and compared on independent datasets. Results Predictive ability on a test set for multiple ED visits (≥3 times within a year) measured as the area under the receiver operating characteristic (ROC) reached 0.8, which is good for a national survey. Models revealed consistency in predictive factors across the 4 survey years. The most influential variables for predicting ≥3 ED visits per year were fair/poor self-rated health, being nervous or restless/fidgety, having a lower income, asthma, heart condition/disease, having chronic obstructive pulmonary disease (COPD), nicotine dependence, African-American race, female sex, having diabetes, and being of younger age (18–20). Conclusions The findings reveal the need to address behavioral and mental health contributors to ED visits and reinforce the importance of developing integrated care models in primary care settings to improve mental health for medically vulnerable patients. The presented modeling approach can be broadly applied to national and other large surveys.

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National trends in mental health-related emergency department visits by children and adults, 2009–2015

Cited by 84 publications

References 41 publications

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

Equity in Emergency Mental Health Care

Predictive model of multiple emergency department visits among adults: analysis of the data from the National Survey of Drug Use and Health (NSDUH)

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