scholarly journals Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments

2017 ◽  
Vol 70 (2) ◽  
pp. 193-202.e16 ◽  
Author(s):  
Mark D. Pearlmutter ◽  
Kristin H. Dwyer ◽  
Laura G. Burke ◽  
Niels Rathlev ◽  
Louise Maranda ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Mental Health Patients

Management of Mental Health Patients Attending Victorian Emergency Departments

2007 ◽  
Vol 41 (9) ◽  
pp. 759-767 ◽  
Author(s):  
Jonathan C. Knott ◽  
Alex Pleban ◽  
David Taylor ◽  
David Castle
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
Significant Variation ◽  
Mental Health Disorder ◽  
Patient Demographics ◽  
Mental Health Patients ◽  
Optimal Patient Care ◽  
Icd 10

Objective: To evaluate the management of mental health presentations to Victorian emergency departments. Method: An observational study in five Victorian emergency departments (four metropolitan and one regional). All patients with an ICD-10 discharge diagnosis for a predetermined mental health disorder were included. Data were collected on patient demographics, presentation, clinical management (emergency and mental health) and disposition. Results: There were 3702 patients enrolled (96.0% of all mental health presentations). At presentation 39.1% were intoxicated and 39.9% arrived by ambulance, 17.6% with the police. There was a significant variation (p <0.001) between sites for: the median time to be seen by a clinician (14 vs 43 min), the time between referral to and review by mental health services (15 vs 50 min), the median time in the emergency department (208 min vs 380 min), the proportion who spent >24 h in the emergency department (0.0% vs 11.6%) and disposition (proportion discharged home from ED 49.8% vs 63.5%). Conclusion: Important variations were identified in the management of patients with mental health presentations to Victorian emergency departments. This variation is most likely due to differing access to resources. All levels of administration must work with carers and patients to ensure that optimal patient care is provided at every site.

scholarly journals MP04: rEDirect: safety and compliance of an emergency department diversion protocol for mental health and addictions patients

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S43
Author(s):  
V. Bismah ◽  
J. Prpic ◽  
S. Michaud ◽  
N. Sykes ◽  
J. Amyotte ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Vital Signs ◽  
Mortality Data ◽  
Transport Protocol ◽  
Patient Morbidity ◽  
Mental Health Patients ◽  
Ed Overcrowding ◽  
Pilot Implementation ◽  
Withdrawal Management

Introduction: Transportation of patients better served at an alternative destinations (diversion) is part of a proposed solution to emergency department (ED) overcrowding. We evaluated the pilot implementation of the “Mental Health and Addiction Triage and Transport Protocol”. This is the first Canadian diversion protocol that allows paramedics to transport intoxicated or mental health patients to an alternative facility, bypassing the ED. Our aim was to implement a safe diversion protocol to allow patients to access more appropriate service without transportation to the emergency department. Methods: A retrospective analysis was conducted on patients presenting to EMS with intoxication or psychiatric issues. Study outcomes were protocol compliance, determined through missed protocol opportunities, noncompliance, and protocol failure (presentation to ED within 48 hours of appropriate diversion); and protocol safety, determined through patient morbidity (hospital admission within 48 hours of diversion) and mortality. Data was abstracted from EMS reports, hospital records, and discharge forms from alternative facilities. Data was analyzed qualitatively and quantitatively. Results: From June 1st, 2015 to May 31st, 2016 Greater Sudbury Paramedic Services responded to 1376 calls for mental health or intoxicated patients. 241 (17.5%) met diversion criteria, 158 (12.9%) patients were diverted and 83 (4.6%) met diversion criteria but were transported to the ED. Of the diverted patients 9 (5.6%) represented to the ED &lt;48rs later and were admitted. Of the 158 diversions, 113 (72%) were transported to Withdrawal Management Services (WMS) and 45 (28%) were taken to Crisis Intervention (CI). There was protocol noncompliance in 77 cases, 69 (89.6%) were due to incomplete recording of vital signs; 6 (10.3%) were direct protocol violations of being transferred with vital sings outside the acceptable range. Conclusion: The Mental Health and Addiction Triage and Transport Protocol has the potential to safely divert 1 in 6 mental health or addiction patients to an alternative facility.

scholarly journals Type of facility influences lengths of stay of children presenting to high volume emergency departments

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rhonda J. Rosychuk ◽  
Brian H. Rowe
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
High Volume ◽  
Population Based ◽  
Initial Assessment ◽  
Teaching Hospitals ◽  
Emergency Department Crowding ◽  
Academic Teaching ◽  
The Impact

Abstract Background Emergency department crowding may impact patient and provider outcomes. We describe emergency department crowding metrics based on presentations by children to different categories of high volume emergency departments in Alberta, Canada. Methods This population-based retrospective study extracted all presentations made by children (age < 18 years) during April 2010 to March 2015 to 15 high volume emergency departments: five regional, eight urban, and two academic/teaching. Time to physician initial assessment, and length of stay for discharges and admissions were calculated based on the start of presentation and emergency department facility. Multiple metrics, including the medians for hourly, facility-specific time to physician initial assessment and length of stay were obtained. Results About half (51.2%) of the 1,124,119 presentations were made to the two academic/teaching emergency departments. Males presented more than females (53.6% vs 46.4%) and the median age was 5 years. Pediatric presentations to the three categories of emergency departments had mostly similar characteristics; however, urban and academic/teaching emergency departments had more severe triage scores and academic/teaching emergency departments had higher admissions. Across all emergency departments, the medians of the metrics for time to physician initial assessment, length of stay for discharges and for admission were 1h11min, 2h21min, and 6h29min, respectively. Generally, regional hospitals had shorter times than urban and academic/teaching hospitals. Conclusions Pediatric presentations to high volume emergency departments in this province suggest similar delays to see providers; however, length of stay for discharges and admissions were shorter in regional emergency departments. Crowding is more common in urban and especially academic emergency departments and the impact of crowding on patient outcomes requires further study.

scholarly journals Attendance at the accident and emergency department in the year before suicide: Retrospective study

2003 ◽  
Vol 183 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Isaura Gairin ◽  
Allan House ◽  
David Owens
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Service ◽  
Health Service ◽  
Health Services ◽  
Emergency Departments ◽  
Accident And Emergency ◽  
Self Harm ◽  
Accident And Emergency Department ◽  
Service Contact

BackgroundThe National Confidential Inquiry into suicides in England and Wales found that a quarter of suicides are preceded by mental health service contact in the year before death. However, visits to accident and emergency departments due to self-harm may not lead to a record of mental health service contact.AimsTo determine the proportion of suicides preceded by accident and emergency attendance in the previous year.MethodWe obtained the list of probable suicides in Leeds for a 38-month period, and examined the records from thecity's accident and emergency departments for a year before each death.ResultsEighty-five (39%) of the 219 people who later died by suicide had attended an accident and emergency department in the year before death, 15% because of non-fatal self-harm. Final visits dueto self-harm were often shortly before suicide (median 38 days), but the National Confidential Inquiry recorded about a fifth of them as‘not in contact’ with local mental health services.ConclusionsAlthough many suicides are preceded by recent attendance at accident and emergency departments due to non-fatal self-harm, local mental health service records may show no recent contact. Suicide prevention might be enhanced were accident and emergency departments and mental health services to work together more closely.

Emergency department contact prior to suicide in mental health patients

2010 ◽  
Vol 28 (6) ◽  
pp. 467-471 ◽  
Author(s):  
D. Da Cruz ◽  
A. Pearson ◽  
P. Saini ◽  
C. Miles ◽  
D. While ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Patients

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 Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

2022 ◽  
Author(s):  
Ronny Otto ◽  
Sabine Blaschke ◽  
Wiebke Schirrmeister ◽  
Susanne Drynda ◽  
Felix Walcher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Management Strategies ◽  
Organizational Factors ◽  
Related Factors ◽  
Adult Age ◽  
Emergency Department Data ◽  
Data Registry

AbstractSeveral indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

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