Disparities in Emergency Department Wait Time Among Patients with Mental Health and Substance-Related Disorders

2017 ◽  
Author(s):  
Samuel T. Opoku ◽  
Bettye A. Apenteng ◽  
Emmanuel A. Akowuah ◽  
Soumitra Bhuyan
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Wait Time ◽  
Substance Related Disorders

scholarly journals The impact of the Emergency Department target upon the discharge decision for people who self-harm

2019 ◽  
Vol 19 (2) ◽  
pp. 89-97
Author(s):  
Michael Brian Haslam ◽  
Emma S. Jones
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Wait Time ◽  
Adverse Outcomes ◽  
Patient Journey ◽  
Content Type ◽  
Target Time ◽  
Starting Point ◽  
Self Harm ◽  
The Impact

Purpose The purpose of this paper is to consider the influence of the Emergency Department (ED) target wait time upon the discharge decision in ED, specifically for patients who have self-harmed. Pressures to discharge patients to avoid breaching the 4-h target wait time, potentially increase the risk of adverse responses from clinicians. For the patient who has self-harmed, such interactions may be experienced as invalidating and may result in adverse outcomes. Design/methodology/approach Secondary data analysis was applied to the retrospective referral data of a Mental Health Liaison Team (MHLT), collected over a period of 11 months from a single hospital in the North of England. In total, 734 episodes of care were referred to the team from ED, where the primary presentation was recorded as self-harm. Findings Over half of patients referred to the MHLT from ED having self-harmed were seen after already breaching the target and the potential for a more restrictive outcome reduced. Of those patients seen within 4 h, the potential for a more restrictive treatment option was increased. Practical implications Recommendations to improve the patient journey for those who have self-harmed include mental health triage and treatment in clinical areas outside of the target. Social implications This study challenges the concept of the target as being realistic and attainable for patients who have self-harmed. Originality/value This exploratory study provides a starting point from which to explore the impact of the target time upon discharge decisions and clinical outcomes specifically for those who have self-harmed.

scholarly journals Children’s Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Amanda S. Newton ◽  
Sachin Rathee ◽  
Simran Grewal ◽  
Nadia Dow ◽  
Rhonda J. Rosychuk
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Length Of Stay ◽  
Wait Time ◽  
Factors Affecting ◽  
Hazard Ratios ◽  
Laboratory Investigations ◽  
Logistic Regressions ◽  
Pediatric Mental Health ◽  
Triage Level

Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS).Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs).Results. Sex (male:HR=1.48, 95%CI=1.20–1.84), ED type (pediatric ED:HR=5.91, 95%CI=4.16–8.39), and triage level (Canadian Triage and Acuity Scale (CTAS) 2:HR=3.62, 95%CI=2.24–5.85) were statistically significant predictors of wait time. ED type (pediatric ED:HR=1.71, 95%CI=1.18–2.46), triage level (CTAS 5:HR=2.00, 95%CI=1.15–3.48), number of consultations (HR=0.46, 95%CI=0.31–0.69), and number of laboratory investigations (HR=0.75, 95%CI=0.66–0.85) predicted LOS.Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.

scholarly journals Costs and Savings Associated With the Police Use of the interRAI Brief Mental Health Screener

2021 ◽  
Vol 12 ◽  
Author(s):  
Ron Hoffman ◽  
Jeffrey Harman ◽  
Heidi Kinsell ◽  
Gregory Brown
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Police Officers ◽  
Cost Efficiency ◽  
Secondary Data ◽  
Wait Time ◽  
Crisis Intervention Team ◽  
Police Response ◽  
Comprehensive Evaluations ◽  
Intervention Team

Background: The police response to calls for service identified as being related to mental health continues to be highly controversial. Strategies to improve the police response include Crisis Intervention Team (CIT) training and various forms of co-response models neither of which have been subjected to comprehensive evaluations, particularly as to cost-efficiency. A new approach is the use of the interRAI Brief Mental Health Screener to enhance police officer ability to identify persons with serious mental disorders. The purpose of the current study is to evaluate the costs and cost efficiency of the police response to mental health calls using the interRAI Brief Mental Health Screener.Method: Secondary data was analyzed from the use of the screener from 2018 to 2020 by police officers in a mid-sized Canadian city. Changes were measured in the overall number of interactions police officers had with persons with mental health disorders, the number of incidents where police officers referred the person to hospital, and the time officers remained in the emergency department.Results: A total of 6,727 assessments were completed with involuntary referrals decreasing by 30%, and voluntary referrals by 34%. The overall time police officers were involved in involuntary referrals decreased from 123 min in 2018 to 113 min in 2020. The average emergency department wait time for voluntary referrals dropped from 41 min in 2018 to 27 min in 2020, while involuntary referrals decreased from 61 min in 2018 to 42 min in 2020. Each averted involuntary referral to the emergency department resulted in a savings of $81, on average during the study period.Conclusion: An analysis of the costs and costs savings associated with the use of the screener demonstrate that it is a worthwhile investment for police services. An additional benefit is its ability to collect mental health statistics that may be useful to police leaders to justify budgets. Future studies should attempt to devise some method of collecting pre-implementation data that would reveal the true costs and cost-efficiency of using the BMHS, which have been shown to be significant in the current study however, undoubtedly are under-estimated.

scholarly journals Occult suicidality in an emergency department population

2005 ◽  
Vol 186 (4) ◽  
pp. 352-353 ◽  
Author(s):  
Cynthia A. Claassen ◽  
Gregory L. Larkin
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Suicidal Ideation ◽  
Emergency Treatment ◽  
Attempted Suicide ◽  
Mental Health Screening ◽  
Waiting Room ◽  
Almost All ◽  
Substance Related Disorders ◽  
Record Review

SummaryThe prevalence and severity of suicidal ideation was established in a patient sample seeking emergency treatment for non-psychiatric reasons. Using a computerised mental health screening panel, data were collected from waiting-room patients during randomised shifts over a 45-day period. Of 1590 screened patients, 185 (11.6%) acknowledged suicidal ideation and 31 (2%) reported planning to kill themselves. Almost all of those with suicidal ideation (97%) acknowledged symptoms consistent with mood, anxiety and/or substance-related disorders. Structured medical record review revealed that 25 of the 31 patients planning suicide were undetected during their index visit, and that 4 attempted suicide within 45 days of the visit. All survived.

scholarly journals The Impact of a Smoking Cessation Policy on Visits to a Psychiatric Emergency Department

2008 ◽  
Vol 53 (11) ◽  
pp. 779-782 ◽  
Author(s):  
Paul Kurdyak ◽  
John Cairney ◽  
Anna Sarnocinska-Hart ◽  
Russell C Callahan ◽  
Carol Strike
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Smoking Cessation ◽  
Emergency Department Visit ◽  
Psychotic Disorders ◽  
Diagnostic Category ◽  
Primary Diagnosis ◽  
Psychiatric Emergency ◽  
Substance Related Disorders ◽  
The Impact

Objective: Smoking cessation policies are increasingly imposed in mental health facilities because of the high prevalence of tobacco smoking and its related adverse health consequences. The objective of this study was to measure the impact of 2 smoking cessation policies—one imposed in a specific psychiatric hospital and the other across the entire province of Ontario—on weekly visit rates to a psychiatric emergency department. Methods: Administrative data records from consecutive patient visits to a psychiatric emergency department were grouped by week from March 1, 2002, to December 31, 2005. The patients were grouped into 3 broad diagnostic categories: substance-related disorders, psychotic disorders, and other disorders. The impact of 2 smoking cessation policies—one imposed on September 21, 2005 at the Centre for Addiction and Mental Health (CAMH) and one imposed on May 31, 2006 across the province of Ontario—on psychiatric emergency department visit rates was measured using time series analysis. Results: The CAMH-specific smoking cessation policy had no impact on psychiatric emergency department visit rates in any diagnostic category. The province-wide smoking cessation policy resulted in a 15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder. Conclusions: The benefits of a smoking cessation policy need to be balanced by the impact of the policy on the likelihood of patients to seek treatment.

Mental health presentations to a paediatric emergency department

2020 ◽  
Author(s):  
Angelo Tolentino ◽  
Linda Symington ◽  
Faye Jordan ◽  
Frances Kinnear ◽  
Mairi Jarvis
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency

scholarly journals P029: Requesting prescriptions in the emergency department: the patient, the request and the response

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S74-S75
Author(s):  
L. Shepherd ◽  
M. Mucciaccio ◽  
K. VanAarsen
Keyword(s):  
Emergency Department ◽  
Family Doctor ◽  
Wait Time ◽  
Primary Objective ◽  
Urgent Care ◽  
Care Centre ◽  
Medication Prescription ◽  
Physician Decision Making ◽  
Service Gap ◽  
Urgent Care Centre

Introduction: Patients presenting to the Emergency Department (ED) for the sole purpose of requesting prescriptions are problematic. Problematic for the patient, who may have a long wait to be seen and may leave dissatisfied. Problematic for the ED physician, who is in the business of episodic not comprehensive care and is diligently trying to avoid the misappropriation of medications. The primary objective of this study was to determine the characteristics of patients who present to the ED or Urgent Care Centre (UCC) requesting a prescription, the nature of these requests and the resulting action by the attending physician. The secondary objective was to determine the proportion of medication requests and responses that have potential street value. With this knowledge we may be better positioned to serve these patients and support physician decision-making. Methods: This was a single-centre, retrospective electronic chart review looking at all adult patients with a presenting complaint of medication request who attended a two-site tertiary ED or an Urgent Care Centre (UCC) in London, Ontario between April 1, 2014 and June 30, 2017. Data was tested for normality and analyzed using descriptive statistics. Results: A total of 1923 cases met the inclusion criteria. Cases were removed (n = 421) if it was unclear which prescription was requested or if a non-medication prescription or injection was requested. The patient median (IQR) age was 44 (32-54) with 58% being male and 55% having a family doctor. There were a total of 2261 prescriptions requested by 1502 patients. The top 3 most commonly requested classes of medications were opioids 433/1502 (28.8%), antidepressants/antipsychotics 371/1502 (24.7%) and benzodiazepines 252/1502 (16.8%). The median (IQR) wait time was 73 minutes (35-128). 298/1502 (19.8%) of patients received their requested prescription (opioids 12.7%; antidepressant/antipsychotic 55.3% and benzodiazepines 16.3%). 740/1502 (49.3%) of patients requested a medication that had street value. Of those, 118/740 (15.9%) received the requested medication. Conclusion: There is no “one size fits all” solution for the patient who presents to the ED requesting a prescription. The large number of requests for psychiatric medications suggests a service gap for mental health patients in the community. This data supports the need for comprehensive electronic medication records to guide physicians’ decisions.

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