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 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

scholarly journals A descriptive analysis of the impact of COVID-19 on Emergency Department attendance and visit characteristics in Singapore

2021 ◽  
Author(s):  
Mei Qiu Lim ◽  
Fahad Javaid Siddiqui ◽  
Seyed Ehsan Saffari ◽  
Andrew Fu Wah Ho ◽  
Johannes Nathaniel Min Hui Liew ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Disease ◽  
Descriptive Analysis ◽  
Circuit Breaker ◽  
Historical Period ◽  
Management Planning ◽  
Crowd Management ◽  
Patient Demographics ◽  
Icd 10 ◽  
The Impact

Abstract Background: The coronavirus disease 2019 (COVID-19) has impacted the utilisation of Emergency Department (ED) services worldwide. This study aims to describe the changes in attendance of a single ED and corresponding patient visit characteristics before and during the COVID-19 period. Methods: In a single-centre retrospective cohort study, we used descriptive statistics to compare ED attendance, patient demographics and visit characteristics during the COVID-19 period (1 January – 28 June 2020) and its corresponding historical period in 2019 (2 January – 30 June 2019). Results: Mean ED attendance decreased from 342 visits/day in the pre-COVID-19 period, to 297 visits/day in the COVID-19 period. This was accompanied by a decline in presentations in nearly every ICD-10-CM diagnosis category except for respiratory-related diseases. Notably, we observed reductions in visits by critically ill patients and severe disease presentations during the COVID-19 period. We also noted a shift in ED patient case-mix from ‘Non-fever’ cases to ‘Fever’ cases, likely giving rise to two distinct trough-to-peak visit patterns during the pre-Circuit Breaker and Circuit Breaker period. Conclusions: This descriptive study revealed distinct ED visit trends across different time periods. The COVID-19 pandemic caused a reduction in ED attendances amongst patients with low-acuity conditions and those with highest priority for emergency care. This raises concern about treatment-seeking delays and possible impact on health outcomes. The downward trend in low-acuity presentations also presents learning opportunities for ED crowd management planning in a post-COVID-19 era.

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 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.

Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

2020 ◽  
Author(s):  
Andrew Fletcher ◽  
Erik Forsman ◽  
Brian R Jackson
Keyword(s):  
United States ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
The United States ◽  
Published Data ◽  
Time Interval ◽  
Time Intervals ◽  
Convenience Sample ◽  
Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

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 Protective jurisdiction, patient autonomy and paramedics: the challenges of applying the NSW Mental Health Act

2009 ◽  
Vol 7 (4) ◽  
Author(s):  
Ruth Townsend ◽  
Morgan Luck
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Patient Autonomy ◽  
Ethical Dilemmas ◽  
Clear Understanding ◽  
Mental Health Patients ◽  
Optimal Patient Care ◽  
Form Part ◽  
Community Changes ◽  
Health Laws

Paramedics form part of the frontline response to mental health care in the community. Changes to mental health laws across the country have seen an increase in the role and responsibilities paramedics have in assessing, treating and managing mental health patients. The increasing complexity of the paramedic role associated with these changes requires a clear understanding of the legal, ethical and organisational requirements that accompany them. This paper will examine the relevant legislative principles and ethical dilemmas that are raised by these changes and will demonstrate the need for further research to assist in the development and implementation of strategies to assist paramedics in providing optimal patient care to a vulnerable section of the community.

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