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Bui LN, Knox M, Miller-Rosales C, Meara E, Rodriguez HP. Hospital Capabilities Associated With Behavioral Health Integration Within Emergency Departments. Med Care 2024; 62:170-174. [PMID: 38241078 PMCID: PMC10871566 DOI: 10.1097/mlr.0000000000001973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
OBJECTIVES To identify hospital capabilities associated with behavioral health (BH) processes in emergency departments (EDs). RESEARCH DESIGN Six hundred two hospital responses to the 2017/2018 National Survey of Healthcare Organizations and Systems were linked to 2017 American Hospital Association Annual Survey data. Separate multivariable regressions estimated how hospital capabilities (the use of quality improvement methods, approaches to disseminate best patient-care practices, barriers to using care delivery innovations, and inpatient beds for psychiatric or substance use) were associated with each of 4 ED-based BH processes: mental health and substance use disorder screening, team-based approaches to BH, telepsychiatry, and direct referrals to community-based BH clinicians. Models controlled for hospital structural characteristics and area-level socioeconomic factors. RESULTS Most hospitals screened for BH conditions and provided direct referrals to community-based BH clinicians. Approximately half of the hospitals used a team approach to BH. A minority had implemented telepsychiatry. Each additional process used to disseminate best patient-care practices was associated with more screening for BH conditions (an increase of 4.07 points on the screening index, P <0.01) and greater likelihood of using a team approach to BH [4.41 percentage point ( P <0.01) increase]. Hospitals reporting more barriers to the use of care delivery innovations reported less screening and use of a team approach [a decrease of 0.15 points on the screening index ( P <0.01) and 0.28 percentage points reduction in likelihood of team approach use ( P <0.001) for 1-point increase in the barrier index]. CONCLUSIONS Research and interventions focused on removing innovation barriers or adding processes to disseminate best practices offer a path to accelerate BH integration in hospital EDs.
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Affiliation(s)
- Linh N. Bui
- Public Health Program, Nursing Department, California State University, Bakersfield, Bakersfield, CA
| | - Margae Knox
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA
| | | | - Ellen Meara
- Department of Health Policy and Management, Harvard T.H.Chan School of Public Health, Boston, MA
| | - Hector P. Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA
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Austin EE, Cheek C, Richardson L, Testa L, Dominello A, Long JC, Carrigan A, Ellis LA, Norman A, Murphy M, Smith K, Gillies D, Clay-Williams R. Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Front Psychiatry 2024; 15:1368129. [PMID: 38487586 PMCID: PMC10937575 DOI: 10.3389/fpsyt.2024.1368129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Background Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness. Method We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools. Results A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging. Conclusion Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.
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Affiliation(s)
- Elizabeth E. Austin
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Colleen Cheek
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Lieke Richardson
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Luke Testa
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Amanda Dominello
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Janet C. Long
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Ann Carrigan
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Louise A. Ellis
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Alicia Norman
- Centre for the Health Economy, Macquarie University Business School, Macquarie University, Macquarie, NSW, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
| | - Kylie Smith
- Emergency Care Institute, New South Wales Agency for Clinical Innovation, New South Wales Health, Sydney, NSW, Australia
| | - Donna Gillies
- Quality and Safeguards Commission, National Disability Insurance Scheme, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
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Bahji A, Altomare J, Sapru A, Haze S, Prasad S, Egan R. Predictors of hospital admission for patients presenting with psychiatric emergencies: A retrospective, cohort study. Psychiatry Res 2020; 290:113149. [PMID: 32512355 DOI: 10.1016/j.psychres.2020.113149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Rising psychiatric visits represent a significant and growing burden for emergency departments (EDs) across Canada. For individual psychiatric conditions, there are likely a variety of demographic and social variables that may increase risk of resource intensive hospital admission. METHODS We conducted a retrospective cohort study of all patients admitted into inpatient psychiatric units from two EDs in Kingston, Ontario, Canada from 2015 to 2018. We collected demographic and social variables from an electronic ED information system inclusive of all patients presenting to the ED with a mental health or addictions-related chief complaint. We used multivariate logistic regression models to identify predictors of psychiatric admission. RESULTS A total of 23,814 patients (49.1% male, median age 33) were identified. Admitted patients (n=1838) tended to be older (49 vs. 31 years), have lower Canadian Triage Acuity Scale scores (2.6 vs. 3.0), arrive by ambulance (51% vs. 35%) or police (18% vs. 9%), and have longer lengths of stay (8.4 vs. 4.9 hours). Individuals with mood and psychotic disorders were more likely to require a hospital admission. CONCLUSION A variety of clinical and demographic variables increased the risk of hospital admissions for individuals with a variety of psychiatric disorders.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada; Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
| | | | - Amer Sapru
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Spencer Haze
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Samir Prasad
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rylan Egan
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
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Johnston ANB, Spencer M, Wallis M, Kinner SA, Broadbent M, Young JT, Heffernan E, Fitzgerald G, Bosley E, Keijzers G, Scuffham P, Zhang P, Martin‐Khan M, Crilly J. Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review. Emerg Med Australas 2019; 31:715-729. [DOI: 10.1111/1742-6723.13335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/17/2019] [Accepted: 05/23/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Amy NB Johnston
- Health and Behavioural SciencesThe University of Queensland Brisbane Queensland Australia
- Department of Emergency MedicinePrincess Alexandra Hospital, Metro South Health Brisbane Queensland Australia
| | - Melinda Spencer
- Menzies Health Institute QueenslandGriffith University Brisbane Queensland Australia
| | - Marianne Wallis
- School of Nursing and MidwiferyUniversity of the Sunshine Coast Sunshine Coast Queensland Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global HealthThe University of Melbourne Melbourne Victoria Australia
| | - Marc Broadbent
- School of Nursing and MidwiferyUniversity of the Sunshine Coast Sunshine Coast Queensland Australia
| | - Jesse T Young
- The University of Melbourne Melbourne Victoria Australia
| | - Ed Heffernan
- Queensland Centre for Mental Health Research Brisbane Queensland Australia
| | - Gerry Fitzgerald
- Queensland University of Technology Brisbane Queensland Australia
| | - Emma Bosley
- Queensland Ambulance Service Brisbane Queensland Australia
| | - Gerben Keijzers
- Gold Coast University Hospital Gold Coast Queensland Australia
| | - Paul Scuffham
- Menzies Health Institute QueenslandGriffith University Brisbane Queensland Australia
| | - Ping Zhang
- Griffith University – Gold Coast Campus Gold Coast Queensland Australia
| | - Melinda Martin‐Khan
- Centre for Health Services ResearchThe University of Queensland Brisbane Queensland Australia
| | - Julia Crilly
- Gold Coast Hospital and Health Service Gold Coast Queensland Australia
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