Wait times in the emergency department for patients with mental illness

Atzema, Clare L.; Schull, Michael J.; Kurdyak, Paul; Menezes, Natasja; Wilton, Andrew S.; Vermuelen, Marian J.; Austin, Peter C.

doi:10.1503/cmaj.111043

Cited by 18 publications

(13 citation statements)

References 16 publications

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“…In terms of LOS, around forty percent of MH patients were not discharged within the four hour target and over ten percent had a LOS of over eight hours. While this is concerning, the findings is consistent with the long LOS reported by other studies (9,12,20,(47)(48)(49). The median LOS of 3.43 reported here is lower than the median LOS reported in other studies; e.g.…”

Section: Discussionsupporting

confidence: 92%

An examination of the profile and journey of patients with mental illness in the emergency department

Coates

David

Roberts

et al. 2019

International Emergency Nursing

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Section: Discussionsupporting

confidence: 92%

An examination of the profile and journey of patients with mental illness in the emergency department

Coates

David

Roberts

et al. 2019

International Emergency Nursing

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“…Specific codes for each diagnosis are listed in supplementary Table 1. Triage status was measured on a five-point scale and combined into low (suicidal/depressed or other milder psychiatric complaints and not agitated), medium (acute psychosis and/or suicidal) and high triage (patients experiencing acute psychosis/extreme agitation) 24 . We also included whether they had any comorbidities included in the Charlson comorbidity index as assessed in the year prior to admission.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study

et al. 2018

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BackgroundInvoluntary admissions to psychiatric hospitals are common; however, research examining the trends in prevalence over time and predictors is limited.AimsTo examine trends in prevalence and risk factors for involuntary admissions in Ontario, Canada.MethodWe conducted an analysis of all mental health bed admissions from 2009 to 2013 and assessed the association between patient sociodemographics, service utilisation, pathway to care and severity characteristics for involuntary admissions using a modified Poisson regression.ResultsWe found a high and increasing prevalence of involuntary admissions (70.7% in 2009, 77.1% in 2013, 74.1% overall). Individuals with police contact in the prior week (risk ratio (RR) = 1.20) and immigrants both experienced greater likelihood of being involuntarily admitted, regardless of control for other characteristics (RR = 1.07) (both P < 0.0001).ConclusionsWe identified numerous modifiable and non-modifiable risk factors for involuntary admissions. The prevalence of involuntary admissions was high, linearly increasing over time.Declaration of interestThe authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This study was conducted using funding entirely from public sources. P.K. has received operational support via an Ontario Ministry of Health and Long-Term Care (MOHLTC) Health Services Research Fund Capacity Award to support this project. The Institute for Clinical Evaluative Sciences (ICES) is funded by the Ontario MOHLTC. The study results and conclusions are those of the authors, and should not be attributed to any of the funding agencies or sponsoring agencies. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. All decisions regarding study design, publication, and data analysis were made independent of the funding agencies.

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“…The increased risk of an adverse event after an ED discharge was higher when crowding was measured using the LOS in the ED instead of EDV. Nevertheless, it is difficult to interpret the results generated with LOS as the exposure because the trend of the ORs is not always linear, unlike in other similar studies [ 9 , 13 ]; this is probably due to the spurious nature of LOS. As was already indicated by Gabayan [ 16 ] and as indicated by our results, LOS is not only a measure of ED crowding but also strongly depends on the severity of a patient’s condition.…”

Section: Discussionmentioning

confidence: 80%

“…In contrast, a successive study found that ED crowding did not have any association with a patient’s treatment time [ 27 ]. In Ontario patients with mental illness could wait longer than others during not crowded periods but also waited for significantly less time when the level of crowding increased [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of ED crowding in the Lazio Region (Italy) and short-term health outcomes

Mataloni¹,

Pinnarelli²,

Perucci³

et al. 2018

Intern Emerg Med

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The effect of emergency department (ED) crowding on patient care has been studied for several years in the scientific literature. We evaluate the association between ED crowding and short-term mortality and hospitalization in the Lazio region (Italy) using two different measures. A cohort of visits in the Lazio region ED during 2012-2014 was enrolled. Only discharged patients were selected. ED crowding was estimated using two measures, length of stay (LOS), and Emergency Department volume (EDV). LOS was defined as the interval of time from entrance to discharge; EDV was defined at the time of each new entrance in ED. The outcomes under study were mortality and hospitalization within 7 days from ED discharge. A multivariate logistic model was performed (Odds Ratios, ORs, 95% CI). The cohort includes 2,344,572 visits. ED crowding is associated with an increased risk of short-term hospitalization using both LOS and EDV as exposures (LOS 1-2 h: OR = 1.71, 95% CI 1.66-1.76, LOS 2-5 h: OR = 1.38, 95% CI 1.34-1.43, LOS > 5 h OR = 1.45 95% CI 1.40-1.50 compared to patients with 1 h of LOS; EDV 75°-95° percentile: OR = 1.02, 95% CI 0.99-1.05 and EDV > 95° percentile: OR = 1.06, 95% CI 1.01-1.11 compared to patients with a EDV < 75° percentile upon arrival). Increased risk of short-term mortality is found with increasing level of LOS. High levels of EDV at the time of patients' arrival and longer LOS in ED are associated with greater risks of hospitalization for patients discharged 7 days before. LOS in ED is also associated with an increased risk of mortality.

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Wait times in the emergency department for patients with mental illness

Cited by 18 publications

References 16 publications

An examination of the profile and journey of patients with mental illness in the emergency department

An examination of the profile and journey of patients with mental illness in the emergency department

Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study

Characteristics of ED crowding in the Lazio Region (Italy) and short-term health outcomes

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