Non-compliance in the Emergency Department: Is there a Difference Between Medical and Psychiatric Patient's Reasons and use of the Emergency Department

2016 ◽  
Vol 33 (S1) ◽  
pp. S445-S445 ◽  
Author(s):  
L. Zun
Keyword(s):  
Emergency Department ◽  
Psychiatric Patients ◽  
Admission Rate ◽  
Medical Patients ◽  
Emergency Room Visits ◽  
Drug Compliance ◽  
Psychiatric Illnesses ◽  
Significant Difference ◽  
Competing Interest ◽  
Two Populations

BackgroundIt is estimated that on average up to 50% of patients are non-compliant with their medication, resulting in 28% emergency room visits costing about $8.5 billion annually.ObjectivesThe purpose of this study was to examine, what, if any, differences there are between medical versus psychiatric non-compliant patients with regard to use of the emergency department (ED).Methodsa random sample of patients who present to the ED for medical or psychiatric illnesses and who state that they were non-compliant with their medicine were given the National Health access Survey. They were asked about sources of medical care, drug compliance and reason for non-compliance.ResultsThere were a total of 300 participants in the study. There was no significant difference in the reason both medical and psychiatric patients gave for being non-compliant with their medications that resulted in their ED visit. Each group cited cost as the number one reason for not taking their medication as prescribed. The psychiatric participants who were more likely to get admitted disposition (P = .00), not afford mental health care (P = .01), were not able to get care from other places and used the ED for their psychiatric care (P = .02).ConclusionThere was no difference between the two populations with regards to their reasons for non-compliance that brought them to the ED. Non-compliance of the psychiatric patients compared to the medical patients lead to a higher admission rate.Disclosure of interestThe author has not supplied his declaration of competing interest.

A tribute to Johann Gottlieb Burckhardt-Heussler (1836–1907), the pioneer of psychosurgery

2016 ◽  
Vol 33 (S1) ◽  
pp. S553-S553 ◽  
Author(s):  
M. Arts ◽  
P. Michielsen ◽  
S. Petrykiv ◽  
L. de Jonge
Keyword(s):  
Significant Contribution ◽  
Psychiatric Patients ◽  
Brain Regions ◽  
Medical Community ◽  
Psychiatric Illnesses ◽  
Scientific Papers ◽  
Show Evidence ◽  
Competing Interest ◽  
Chronic Psychiatric Patients ◽  
Deep Brain

IntroductionJohann Gottlieb Burckhardt-Heussler was a Swiss psychiatrist, who pioneered controversial psychosurgical procedures. Burckhardt-Heussler extirpated various brain regions from six chronic psychiatric patients under his care. By removing cortical tissue he aimed to relieve the patients of symptoms, including agitation, rather than effect a cure.ObjectivesTo present the scientific papers of Johann Gottlieb Burckhardt-Heussler on psychosurgery.AimsTo review available literature and to show evidence that Burckhardt-Heussler made a significant contribution to the development of psychosurgery.MethodsA biography and private papers are presented and discussed, followed by a literature review.ResultsThe theoretical basis of Burckhardt-Heussler's psychosurgical procedure was influenced by the zeitgeist and based on his belief that psychiatric illnesses were the result of specific brain lesions. His findings were ignored by scientists to make them disappear into the mists of time, while the details of his experiments became murky. Decades later, it was the American neurologist Walter Freeman II, performing prefrontal lobotomies since 1936, who found it inconceivable that the medical community had forgotten Burckhardt-Heussler and who conceded that he was familiar with, and probably even influenced by, Burckhardt's work.ConclusionIt is partly thanks to Burckhardt-Heussler's pioneering work that modern psychosurgery has gradually evolved from irreversible ablation to reversible stimulation techniques, including deep brain stimulation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Outcomes in Vaso-Occlusive Crisis Treatment in the Emergency Department Vs. Acute Care Observation Center

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-23
Author(s):  
Renee Cheng ◽  
Avani Singh ◽  
Xu Zhang ◽  
Priyanka Nasa ◽  
Jin Han ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Research Funding ◽  
Admission Rate ◽  
Pain Medication ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Data Set ◽  
Admission Rates ◽  
Significant Difference

I NTRODUCTION: Acute painful vaso-occlusive crises (VOC) are the leading cause of emergency department (ED) encounters and hospital admissions for those with sickle cell disease (SCD). For SCD patients, the goal of the sickle cell acute care observation unit (ACOU) at University of Illinois Health (UIH) is to improve patient outcomes by providing immediate care for an uncomplicated VOC. At our urban hospital which cares for more than 500 adult SCD patients, a considerable portion of SCD patients, despite having access to the ACOU, continue to present to the ED for treatment of an uncomplicated VOC. In order to help improve our current system, this study investigated outcomes in SCD patients who receive care for an uncomplicated VOC in the ACOU versus the ED at UIH. METHODS: By querying the electronic medical record, a retrospective study was conducted to analyze outcomes of encounters from the ACOU and ED at UIH between October 2019 and December 2019, specifically including SCD patients ≥18 years old who received morphine for treatment of an uncomplicated VOC. Encounters for complicated VOCs such as acute chest syndrome and stroke were excluded. Endpoints collected include time to first dose of morphine, total milligrams (mg) of IV morphine equivalents given, number of total morphine doses, admission rates, subsequent hospital length of stay, and 30-day inpatient admission rates. Time to the first dose (log transformed) and total dose in mg were analyzed by linear mixed effects models. The number of doses and hospitalization days were analyzed by negative binomial mixed effects model. Admissions and 30-day admissions were analyzed by logistic mixed effects models. These models adjusted for age, gender, and severe Hb genotype (HbSS or HbS beta0-thalassemia) and treated patient identity as random effect. P values were obtained from Wald- test. RESULTS: The ACOU data set contains 394 patient encounters for 79 patients with a median age of 33 years (interquartile range [IQR], 28-40), 71% female, and 73% with severe sickle genotypes. The ED data set contains 391 patient encounters for 128 patients with a median age of 30 years (IQR, 26-41), 53% female, and 74% with severe sickle genotypes. In the ACOU, the median time to first dose of morphine was 49 minutes (IQR, 39-60) compared to 107 minutes (IQR, 71-194) in the ED. The time to first dose was significantly longer in the ED compared to the ACOU (eβ=2.5, p <2×10-16). There was no significant difference in the total number of morphine doses received nor the total mg of morphine received between the two locations. Admission rate from ACOU was 6.6% compared to 53% from ED (OR=0.019, p=2x10-16). Of those admitted, the median number of hospitalization days from the ACOU was 4 days (IQR, 2.3-5.8) and 4 days (IQR, 2.0-6.5) from the ED. There was no significant difference in hospitalization days (p=0.6). The 30-day admission rate was 55% from the ACOU compared to 58% from the ED. 30-day admission rate however had strong intra-patient correlation (i.e., a patient was likely re-admitted multiple times): 44% of patients from the ACOU had admissions within 30 days of their ACOU visit compared to 32% from the ED. Controlling for the intra-patient correlation, ACOU visits had a higher 30-day admission rate than ED visit (OR=2.8, p=0.0015). DISCUSSION: SCD patients treated for an uncomplicated VOC at the sickle ACOU at UIH had a significantly shorter time to initial dose of IV pain medication. The wait time in the ED before first dose of IV pain medication received was more than double than those treated in the ACOU. Patients treated for an uncomplicated VOC in ACOU and ED had similar hospitalization days without a statistically significant difference. The 30-day admission rate to the inpatient setting was comparable for those treated in the ED versus the ACOU. However, given that only 6.6% of patients from the ACOU were admitted during the study period, this suggests that most patients who use both the ED and ACOU tend to be subsequently admitted from the ED. SCD patients may be presenting to the ED for treatment of VOC if capacity in the ACOU is exceeded or are presenting outside of hours of operation (currently 2 shifts Monday through Saturday). Therefore, improving access to our ACOU by increasing capacity and hours of operation may subsequently also lead to a decrease in time to first dose of medication and decrease in the overall 30-day admission rate. Disclosures Gordeuk: Imara: Research Funding; CSL Behring: Consultancy, Research Funding; Global Blood Therapeutics: Consultancy, Research Funding; Novartis: Consultancy; Ironwood: Research Funding.

Hypothyroidism in psychiatric patients

2017 ◽  
Vol 41 (S1) ◽  
pp. s839-s840
Author(s):  
I. Melatto ◽  
M.D.L. Pequeno ◽  
A. Santos ◽  
H. Gilberto ◽  
D. Malheiros ◽  
...  
Keyword(s):  
Memory Impairment ◽  
Psychiatric Patients ◽  
Public Mental Health ◽  
Thyroid Stimulating Hormone ◽  
Brazilian Population ◽  
P Value ◽  
Free T4 ◽  
Public Mental Health Service ◽  
Significant Difference ◽  
Competing Interest

IntroductionHypothyroidism psychocognitive key features may include melancholia, memory impairment, depression and dementia which could be misdiagnosed as a psychiatric disorder.ObjectiveTo study the incidence of hypothyroidism in psychiatric patients.MethodsThis retrospective study included 232 psychiatric patients with mean age of 43.39 ± 10 years old weight mean of 79.81 ± 19.07 kg, BIM of 29.55 ± 6.83, enrolled in a public mental health service.ResultsTwenty point twenty-one percent (39) patients presented hypothyroidism with thyroid-stimulating hormone (TSH) levels above 5 mIU/L and Free T4 levels below 0.7 ng/dl.Comparing the incidence of hypothyroidism in Brazilian population estimated rate of until 10% [1] with this psychiatric patients population we observed a significant difference with p value of 2.28 E-6. Neuroleptics 92%(36), biperiden 62%(24) and benzodiazepines 38% (15) were the most frequent prescribed drugs for these hypothyroidism patients.ConclusionSignificant difference in the incidence of hypothyroidism between general Brazilian population and the studied psychiatric patients was observed [2,3].Disclosure of interestThe authors have not supplied their declaration of competing interest.

The 4-hour window: UK Government targets versus clinical priorities

2017 ◽  
Vol 41 (S1) ◽  
pp. S563-S564
Author(s):  
D. Cumming
Keyword(s):  
Emergency Department ◽  
United Kingdom ◽  
Public Hospital ◽  
Positive Response ◽  
Psychiatric Patients ◽  
Waiting Times ◽  
Adverse Outcomes ◽  
Department Of Health ◽  
Competing Interest ◽  
Image Position

IntroductionIn 2002, the Department of Health (United Kingdom) introduced a 4-hour target due to long waiting times. It is expected that 95% of patients who attend the A&E (Emergency) Department should be registered and admitted/discharged within 4 hours. Exceeding this is termed a “breach”.ObjectivesThe aim of this re-audit was to assess for a response following recommendations after an initial audit with concerning results. Forth Valley Royal is an acute public hospital in Central Scotland with 860 in-patient beds, covering a population of 300,000. It contains two general adult wards (42 beds), one IPCU (12 beds) and two Elderly wards (40 beds).MethodsReferral data was sourced across 4 consecutive months: April–July 2015 (initial audit) and October 2015–January 2016 (re-audit). These included all referrals from A&E to Psychiatry. Times were calculated for the 4 subprocesses listed in Table 1 below.Conclusion/discussionFollowing the initial audit, interventions such as training A&E staff to better manage psychiatric patients and encourage earlier referrals, led to a positive response in the re-audit (Subprocess 1). Breach rates reduced to 28% (from 35%) on re-audit. Less breaches (81% compared to 88%) were referred after 2-hours by A&E. Overall, the breach rates have reduced and they are less attributable to the A&E referring patients late. The outcome of patients leaving A&E without being seen by a psychiatrist was unknown – adverse outcomes would strengthen the debate to enforce the 4-hour window.Disclosure of interestThe author has not supplied his/her declaration of competing interest.Table 1Initial audit = 222 referrals (35% breach rate)Re-Audit = 348 referrals (28% breach rate)

Evaluation Of Psychiatry Attachment On Medical Students’ Attitude To Mental Illness

2016 ◽  
Vol 33 (S1) ◽  
pp. S434-S434
Author(s):  
C. Oliver ◽  
O. Adekunte ◽  
B. Owen
Keyword(s):  
Mental Illness ◽  
Medical Students ◽  
Psychiatric Patients ◽  
Self Control ◽  
Free Text ◽  
Positive Attitudes ◽  
Significant Difference ◽  
Students Attitudes ◽  
Attitudes Toward Mental Illness ◽  
Competing Interest

BackgroundMental illness is subject to stigma, discrimination and prejudice by both healthcare professionals and public. Fortunately, students are still flexible in their beliefs and there is evidence that education in psychiatry may help to positively alter these beliefs. This survey looks into how psychiatry placement positively influences attitudes of medical students to mental illness.AimsTo elicit the effect of clinical attachment in psychiatry on 3rd year medical students’ attitudes toward mental illness.MethodsQuestionnaires were administered to four cohorts of students pre- and post-attachment. Responses were anonymised. Responses were based on Yes/No, free text, order of preference and Likert scale. Analysis was with basic statistical analysis.ResultsNinety-eight pre- and 81 post-placement students responded. There was a 4% increase in mean positive attitude scores following the placement. There was no significant difference in the medical students’ attitudes to violence in mental illness and that patients with mental illness do not want you to help them. Students post-attachment were more likely to disagree with the statement, ‘Psychiatric patients are difficult to like’. However, 6% more students agreed with the statement ‘Alcohol abusers have no self-control’ after the placement!Conclusions and recommendationFollowing the 4-week attachments, the percentage of students reporting more positive attitudes to mental illness showed only a marginal increase. A possible explanation may be insufficient contacts with patients and a feeling of not been part of the treating team.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 112 Impact of the COVID-19 pandemic on emergency department visits at a university medical centre

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e81-e82
Author(s):  
Viviane Mallette ◽  
Claude Cyr
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Emergency Department Visits ◽  
Medical Centre ◽  
Pediatric Care ◽  
Emergency Room Visits ◽  
Traumatic Injuries ◽  
Health Measures ◽  
Significant Difference ◽  
The Impact

Abstract Primary Subject area Emergency Medicine - Paediatric Background The new coronavirus, SARS-Cov-2, responsible for a global pandemic, led to the declaration of a health emergency and the implementation of large-scale public health measures by governments in 2020. Those measures, combined with the overlapping symptoms of COVID-19 disease and common viral infections in children, have led hospitals to prepare for possible changes in volume of emergency room visits by children. Objectives This study aims to determine the effect of the pandemic and governmental restrictions on the use of the emergency department by pediatric patients at a university medical centre, as well as to assess the impact on the severity of initial presentations. Design/Methods A single-centre study was conducted at a university hospital among children aged 0 to 17 who visited the emergency room. We used interrupted time series analysis to compare the average of pre-COVID-19 data (from January 1 2017, to December 31 2019) with data from the first wave of the COVID-19 pandemic (from January 1 to September 2020). Emergency room visits, initial triage codes, and admission and pediatric consultation rates were analyzed to assess whether there was a significant difference between periods. Results An important increase in total daily visits (+11.18, 95% CI [6.23-16.14]) was first observed with the emergence of COVID-19 cases in Canada. Then, during the strict confinement, which corresponds to an active period of COVID-19, we detected a significant drop in daily visits (-25.64, 95% CI [-30.4 to -20.66]), which continued while progressively loosening restrictions. The proportion of admissions and pediatric consultations rose slightly only throughout the time of intensive health measures (respectively +4.07% and +3.32%), but no changes in the severity of the triage codes at the emergency department were observed for all periods. Traumatic injuries also saw a significant decrease (p=0.018) when comparing data by groups of diagnosis. Conclusion These results show a significantly lower number of children’s visits to the emergency room of a university medical centre, and a transient increase in pediatric care with little impact on the immediate severity of the initial presentations during strict government health measures in the first wave of COVID-19. These measures also had a beneficial effect in reducing the number of traumatic injuries.

scholarly journals Does drug compliance change in asthmatic patients during pregnancy?

2013 ◽  
Vol 8 ◽  
Author(s):  
Insu Yilmaz ◽  
Ferda Oner Erkekol ◽  
Sevki Celen ◽  
Mujdegul Zayifoglu Karaca ◽  
Omur Aydin ◽  
...  
Keyword(s):  
Emergency Room ◽  
Pregnant Women ◽  
Systemic Steroid ◽  
Emergency Room Visits ◽  
Behavioral Differences ◽  
Drug Compliance ◽  
Face To Face ◽  
Asthmatic Patients ◽  
Significant Difference ◽  
Symptomatic Asthma

Background: Pregnant women with asthma are recommended to maintain optimal therapeutic management during pregnancy. Uncontrolled, symptomatic asthma may increase the risk of adverse peri-natal outcomes; thus adequate regular anti-asthmatic treatment must be given to provide optimal asthma control during pregnancy. However, doubts about the safety of asthmatic drugs can affect pregnant asthmatic patients’ drug compliance. The aim of this study was to assess behavioral differences in drug compliance among pregnant asthmatic patients. Methods: Thirty two asthmatic and 121 healthy pregnant women were enrolled in the study. Structured face-to-face interviews were conducted after delivery. The interviews included disease characteristics, drug compliance and patients’ own perspective for asthma status prior to and during pregnancy. In addition, medical and pregnancy history, pregnancy complications and outcomes, and newborn characteristics were recorded. Results: In our study group the rates of hospitalization, emergency room visits and systemic steroid use in the year before pregnancy were 13%, 46.9% and 18.8%, respectively. The rate of regular asthma medication use was only 32% at that period and increased to 44% during pregnancy. However, hospitalization, emergency room visits, systemic steroid usage rates remained unchanged and according to patients’ own evaluations, 44% of asthmatics pointed out that their asthma had worsened during pregnancy. No statistically significant difference was detected in terms of pregnancy/labour complication between asthmatic and non-asthmatics. Conclusions: Contrary to some previous studies, in our study regular use of asthma drugs increased during pregnancy. The uncontrolled condition of their asthma before and during pregnancy and the idea that their asthma worsened during pregnancy might force the patients to use medication more regularly.

scholarly journals Comparison of OPD-Referral and Self-Referral Patients In The Emergency Department

2021 ◽  
Author(s):  
Yu-Rung Chou ◽  
Mi-Chia Ma ◽  
Ching-Chi Lee ◽  
Chih-Chia Hsieh ◽  
Chih-Hao Lin
Keyword(s):  
Emergency Department ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Admission Rate ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Tertiary Teaching Hospital ◽  
Referral Status ◽  
Hospital Cardiac Arrest

Abstract Background: To compare outpatient department (OPD) referral patients and self-referral patients in the emergency department (ED) in terms of hospitalization, mortality, and length of stay.Methods: We collected ED patients of a tertiary teaching hospital over a 3-month period. We excluded pediatric patients and patients with certain inconsistent characteristics, such as trauma and out-of-hospital cardiac arrest, or referral from other facilities. After propensity score matching, we compared the hospitalization, mortality, and length of stay in the ED of the OPD-referral patents and self-referral patients. We categorized the patients as “emergency” or “urgency” according to their triage information and then analyzed the effects of different severity levels.Results: The OPD-referral ED patients, compared with the self-referral patients, had a higher admission rate (49.8% vs. 28.9%, p < 0.001; odds ratio [OR] = 2.44, 95% confidence intervals [CIs]: 1.91 - 3.12). Among the emergency patients, there was no significant difference regarding the admission rate (62.6% vs. 55.8%, p = 0.257) or the mortality rate (4.6% vs. 8%, p = 0.253). Among the urgent patients, the admission rate was significantly different between the OPD-referral and self-referral groups (46% vs. 20.2%, p < 0.001; OR = 3.36, 95% CIs: 2.48 - 4.55). The urgent patients who were referred from OPD tended to have a higher mortality rate (2.1% vs. 0.5%, p = 0.064). Regarding the length of ED stay, only the discharge and urgent subgroups differed according to OPD- and self-referral status (p < 0.001), with a median of 5.8 hours versus 2.3 hours.Conclusions: The OPD-referral ED patients have a higher admission rate and a longer length of stay than self-referral patients in urgent triage. The OPD-referral ED patients might have more severe and complex conditions. We should be more alert to OPD-referred patients even when they initially appear not severely ill.

Evaluation of suicide risk in psychiatric patients after discharge. A follow-up study

2016 ◽  
Vol 33 (S1) ◽  
pp. s282-s282
Author(s):  
G. Giordano ◽  
R. Federica ◽  
E. Denise ◽  
M. Monica ◽  
I. Marco ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Risk ◽  
Attempted Suicide ◽  
Psychiatric Patients ◽  
Psychiatric Inpatients ◽  
Type I ◽  
Follow Up Study ◽  
Significant Difference ◽  
Competing Interest

RésuméIntroductionSeveral studies show that the first period after discharge has an higher suicide risk.ObjectivesFollowing up psychiatric inpatients after discharge may be important in order to better understand the risk and the protective factors of suicide.AimThe aim of our follow-up study is to evaluate the predictive factors of suicide in a sample of psychiatric inpatients after discharge.MethodsWe analyzed the temperament and the levels of hopelessness, depression, suicide risk in a sample of 87 (54% males) inpatients at time T0 (during the hospitalization), T1 (12 months after discharge) and T2 (8 months after T1). We administered the following scales: BHS, MINI, TEMPS, GMDS, CGI.ResultsA statistically significant difference on the risk of suicide with substance abuse was found among patients who were followed up and who refused to participate, respectively at T1 (χ24 = 2.61; P < 0.05) and T2 (χ24 = 1.57; P = 0.05). At T1, 4 patients attempted suicide and 18 showed suicidal ideation. In the second follow-up, 1 patient successful committed suicide, 1 subject attempted suicide and 10 patients showed suicidal ideation. Patients with suicidal ideation at T1 showed higher levels of hopelessness and a diagnosis of bipolar disorder type I (χ24 = 10.28; P = 0.05). Sixty-seven percent of subjects with suicidal ideation showed higher scores in the BHS at T1. Significant differences were found on the anxious temperament at T2 between two groups.ConclusionsThe follow-up could represent a significant strategy to prevent suicide in psychiatric patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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