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Sporer KA, Bascombe KM, Trivedi TK, Hong T, Mercer MP. Novel Methodology for Linking 9-1-1 Dispatch Categories with a Death Registry: Mortality Rates of Selected Dispatch Categories. PREHOSP EMERG CARE 2024:1-7. [PMID: 38935488 DOI: 10.1080/10903127.2024.2372442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/03/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Medical Priority Dispatch System (MPDS) is a system used to assign medical 9-1-1 calls to one of 35 chief complaints that are further categorized in order of increasing priority, Alpha through Echo. In this descriptive study we demonstrate the methodology of matching MPDS codes to a county mortality registry. We also evaluated the ability of select MPDS codes (fall, respiratory, sick person, and abdominal pain) to predict mortality up to 30 d for all ages transported by Alameda County Emergency Medical Services (EMS). METHODS Using Alameda County EMS data, we conducted a retrospective review of all EMS encounters that occurred from November 1, 2011, to November 1, 2016. To describe mortality in this population, we identified unique patients and linked them to the Alameda County Public Health Death Registry. We identified mortality at 48 h, 7 d, and 30 d after an EMS encounter. RESULTS Approximately 99% of the EMS encounters were matched with unique patient identifiers, yielding a study sample of 202,431 (4% less than age 18, 53% between ages 18-65, and 43% over age 65). Patients with a respiratory chief complaint had the highest mortality percentage in each age group (0.23%, 2.7%, and 14.55% respectively). There was no correlation between the MPDS code and mortality for patients less than age 18. An increase in Alpha through Echo designation for respiratory complaints in patients 18-65 and older than 65 years corresponded with an increase in 30-day mortality. CONCLUSIONS This study demonstrates an upward trend in mortality with increasing acuity of Alpha through Echo designations for adult patients with respiratory complaints. Mortality increased with age in this cohort. Most of the deaths occurred after 7 days.
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Affiliation(s)
- Karl A Sporer
- Department of Emergency Medicine, UCSF, San Francisco, California
| | - Kristen M Bascombe
- Department of Emergency Medicine, Alameda Health System-Highland Hospital, Oakland, California
| | - Tarak K Trivedi
- Department of Emergency Medicine, University of California, Los Angeles, California
| | - Timothy Hong
- The Permanente Medical Group, San Francisco, California
| | - Mary P Mercer
- Department of Emergency Medicine, Alameda Health System-Highland Hospital, Oakland, California
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2
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Bromley E, Rahmanian Koushkaki S, Davis LG, Moon S, Resnick J, McCoy M, Bennett K, Rab S, Draxler CD, Jackson LT, Lovelace A, Sherin J. Addressing Mental Health Disability in Unsheltered Homelessness: Outpatient Conservatorship in Los Angeles. Psychiatr Serv 2024; 75:689-698. [PMID: 38268464 DOI: 10.1176/appi.ps.20230235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The authors sought to describe a pilot program for gravely disabled individuals experiencing unsheltered homelessness in Los Angeles County that illustrates a promising public health framework to address mental health-related disability in homeless populations. METHODS Homeless outreach teams implementing the outpatient conservatorship (OPC) pilot program adopted a population health approach, multisystem care coordination, and prioritization of the least restrictive environments. The program allowed initiation of a Lanterman-Petris-Short (LPS) conservatorship outside of a hospital, with the goal of serving highly vulnerable individuals in the least restrictive settings. Between August 2020 and July 2021, the OPC pilot program served 43 clients, corresponding to 2% of those served by the outreach teams during that period. Using observational program evaluation data, the authors examined the impact of the program on this sample of participants. RESULTS At 12 months, 81% of OPC clients were no longer experiencing unsheltered homelessness; 65% accessed an LPS conservatorship. Although most OPC clients utilized a psychiatric hospital, 54% left locked settings earlier than would have been possible without the program. One-third of clients referred for LPS conservatorship used unlocked licensed residential facilities in the first year. Negative events, such as remaining in unsheltered homelessness, were more common among clients not referred for LPS conservatorship. CONCLUSIONS Timely receipt of street-based services and coordination of care before, during, and after referral for LPS conservatorship reduced use of restrictive settings. The OPC program's components constitute a promising triadic framework for addressing mental health disability among unsheltered individuals that warrants further investigation.
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Affiliation(s)
- Elizabeth Bromley
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Sara Rahmanian Koushkaki
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Lisa G Davis
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Stephanie Moon
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Jaclyn Resnick
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Matthew McCoy
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Karla Bennett
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Shayan Rab
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Connie D Draxler
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - La Tina Jackson
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Aubree Lovelace
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
| | - Jonathan Sherin
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, and Los Angeles County Department of Mental Health and University of California Los Angeles Public Mental Health Partnership, University of California Los Angeles, Los Angeles (Bromley, Rahmanian Koushkaki, Davis, McCoy, Sherin); Mental Illness Research, Education and Clinical Center, Greater Los Angeles Healthcare System, U.S. Department of Veterans Affairs, Los Angeles (Bromley, McCoy); Los Angeles County Department of Health Services, Los Angeles (Moon); Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla (Resnick); Los Angeles County Department of Mental Health, Los Angeles (Bennett, Rab, Draxler, Jackson, Lovelace)
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Wardrop R, Ranse J, Crilly J, Stubbs N, Chaboyer W. Clinicians' experiences of caring for people brought in by police to the emergency department: A qualitative interpretive study. J Adv Nurs 2024; 80:1955-1966. [PMID: 37994190 DOI: 10.1111/jan.15944] [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] [Received: 03/16/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023]
Abstract
AIM To explore nurses' and doctors' experiences of providing care to people brought in by police (BIBP) to the emergency department (ED). DESIGN A qualitative interpretive study using in-depth individual interviews. METHODS Semi-structured interviews were conducted with nurses and doctors who worked in various EDs in one Australian state and were involved in the care of people BIBP. Interviews were undertaken between May and October 2022 and focused on the structures (i.e., what), processes (i.e., how) and outcomes of care for people BIBP. Data were analysed using deductive and then inductive content analysis. RESULTS Nine nurses and eight doctors were interviewed. Structures described by participants included human structures (staff) and organizational structures (areas for assessment, involuntary assessment orders, investigations, chemical/physical restraints). For processes, participants described practices including risk/mental health assessments, legal considerations, and increased/decreased levels of care compared to other presentations. Communication processes were largely between police and health care staff. Service outcomes pertained to discharge location (custody, community, hospital admission) and length of stay. CONCLUSION The current care delivery for people BIBP to the ED is unique and complex, often occurring in high traffic, resource-intensive areas. There is a need to strengthen structures and processes, to improve service outcomes. IMPLICATIONS FOR THE PROFESSION Understanding the care requirements for people brought into ED by police enables the delivery of targeted care alongside appropriate resource allocation. IMPACT This study provides a comprehensive understanding of the health care requirements for people BIBP to EDs. Interventions delivered in the ED to support health care delivery for people BIBP and foster clinician and police relationships are required to optimize patient and health service outcomes. REPORTING METHOD This study adheres to the COREQ checklist (Table S1) of the EQUATOR guidelines. PATIENT OR PUBLIC CONTRIBUTION This study focused on ED staff experiences.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Centre for Mental Health, Griffith University, Southport, Queensland, Australia
| | - Nicole Stubbs
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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4
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph MM, Schieferle Uhlenbrock J, Brown K, Waseem M, Snow S, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Pediatrics 2023; 152:e2023063256. [PMID: 37584106 DOI: 10.1542/peds.2023-063256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/17/2023] Open
Abstract
Mental and behavioral health (MBH) visits of children and youth to emergency departments are increasing in the United States. Reasons for these visits range from suicidal ideation, self-harm, and eating and substance use disorders to behavioral outbursts, aggression, and psychosis. Despite the increase in prevalence of these conditions, the capacity of the health care system to screen, diagnose, and manage these patients continues to decline. Several social determinants also contribute to great disparities in child and adolescent (youth) health, which affect MBH outcomes. In addition, resources and space for emergency physicians, physician assistants, nurse practitioners, and prehospital practitioners to manage these patients remain limited and inconsistent throughout the United States, as is financial compensation and payment for such services. This technical report discusses the role of physicians, physician assistants, and nurse practitioners, and provides guidance for the management of acute MBH emergencies in children and youth. Unintentional ingestions and substance use disorder are not within the scope of this report and are not specifically discussed.
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Affiliation(s)
- Mohsen Saidinejad
- Department of Clinical Emergency Medicine & Pediatrics, David Geffen School of Medicine at UCLA, Institute for Health Services and Outcomes Research, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, and Department of Emergency Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Susan Duffy
- Department of Emergency Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - Dina Wallin
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, University of Florida Health Sciences Center, Jacksonville, Jacksonville, Florida
| | | | - Kathleen Brown
- Emergency Medicine and Trauma Center, Children's National Hospital, Washington, District of Columbia
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Sally Snow
- Independent Consultant, Pediatric Emergency and Trauma Nursing
| | | | - Alice A Kuo
- Departments of Medicine and Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Carmen Sulton
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, CPG Sedation Services, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia
| | - Thomas Chun
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Medicine at Brown University, Providence, Rhode Island
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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5
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph M, Uhlenbrock JS, Brown K, Waseem M, Snow SK, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. J Emerg Nurs 2023; 49:703-713. [PMID: 37581617 DOI: 10.1016/j.jen.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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6
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph M, Schieferle Uhlenbrock J, Brown K, Waseem M, Snow SK, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK, Conners GP, Callahan J, Gross T, Joseph M, Lee L, Mack E, Marin J, Mazor S, Paul R, Timm N, Dietrich AM, Alade KH, Amato CS, Atanelov Z, Auerbach M, Barata IA, Benjamin LS, Berg KT, Brown K, Chang C, Chow J, Chumpitazi CE, Claudius IA, Easter J, Foster A, Fox SM, Gausche-Hill M, Gerardi MJ, Goodloe JM, Heniff M, Homme JJL, Ishimine PT, John SD, Joseph MM, Lam SHF, Lawson SL, Lee MO, Li J, Lin SD, Martini DI, Mellick LB, Mendez D, Petrack EM, Rice L, Rose EA, Ruttan T, Saidinejad M, Santillanes G, Simpson JN, Sivasankar SM, Slubowski D, Sorrentino A, Stoner MJ, Sulton CD, Valente JH, Vora S, Wall JJ, Wallin D, Walls TA, Waseem M, Woolridge DP, Brandt C, Kult KM, Milici JJ, Nelson NA, Redlo MA, Curtis Cooper MR, Redlo M, Kult K, Logee K, Bryant DE, Cooper MC, Cline K. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Ann Emerg Med 2023; 82:e97-e105. [PMID: 37596031 DOI: 10.1016/j.annemergmed.2023.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
Abstract
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph MM, Uhlenbrock JS, Brown K, Waseem M, Snow S, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Pediatrics 2023; 152:e2023063255. [PMID: 37584147 DOI: 10.1542/peds.2023-063255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/17/2023] Open
Abstract
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure; challenges with timely access to a mental health professional; the nature of a busy ED environment; and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affect patient care and ED operations. Strategies to improve care for MBH emergencies, including systems-level coordination of care, are therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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Affiliation(s)
- Mohsen Saidinejad
- Department of Clinical Emergency Medicine & Pediatrics, David Geffen School of Medicine at UCLA, Institute for Health Services and Outcomes Research, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, and Department of Emergency Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | - Susan Duffy
- Department of Emergency Medicine, Brown University School of Medicine, Providence, Rhode Island
| | - Dina Wallin
- Department of Emergency Medicine, University of California San Francisco, UCSF Benioff Children's Hospital, San Francisco, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Evanston, Illinois
| | - Madeline M Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, University of Florida Health Sciences Center, Jacksonville, Jacksonville, Florida
| | | | - Kathleen Brown
- Emergency Medicine and Trauma Center, Children's National Hospital, Washington, District of Columbia
| | - Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medical Center, Bronx, New York
| | - Sally Snow
- Independent Consultant, Pediatric Emergency and Trauma Nursing
| | | | - Alice A Kuo
- Departments of Medicine and Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Carmen Sulton
- Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, CPG Sedation Services, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia
| | - Thomas Chun
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Hasbro Children's Hospital, Warren Alpert Medical School of Medicine at Brown University, Providence, Rhode Island
| | - Lois K Lee
- Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
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8
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Glomb NW, Trivedi T, Grupp‐Phelan J, Schriger DL, Sporer K. Safety of a prehospital emergency medical services protocol for an alternative destination for pediatric behavioral emergencies in Alameda County. J Am Coll Emerg Physicians Open 2023; 4:e12930. [PMID: 37051504 PMCID: PMC10083547 DOI: 10.1002/emp2.12930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/10/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2023] Open
Abstract
Background Pediatric patients with behavioral health emergencies (BHEs) are often transported to an emergency department (ED) by emergency medical services (EMS), despite having no physical medical complaints, to await psychiatric evaluation and treatment. This process leads to significant delays in their care. We examined the safety of directly transporting pediatric patients with BHEs from the field to an alternative destination of a psychiatric emergency service (PES) facility using an EMS protocol. Methods A retrospective review from November 1, 2011, to November 1, 2016, was conducted for pediatric EMS encounters using EMS data from Alameda County, California. Our primary outcome was the safety of a prehospital alternative destination protocol. We identified the proportion of patients who required retransport to an ED within 24 h after arriving at PES (defined as a failed diversion). We also describe the mortality of all patients being transported for a BHE. Results There were 38,241 total pediatric encounters, with 20.1% for BHEs. A total of 3122 (41%) BHE encounters met protocol criteria and were transported directly to the PES. Only 16 (0.5%) patients had a secondary transport (failed diversion) to an ED within 24 h of arrival. No patients with a BHE transported to the PES died within 30 days of the EMS encounter. Conclusion Death and adverse clinical outcomes are extremely rare in pediatric patients using a prehospital alternative destination protocol. This information could significantly improve the care of children with BHEs.
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Affiliation(s)
- Nicolaus W. Glomb
- Division of Emergency MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Tarak Trivedi
- Department of Emergency MedicineUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Jacqueline Grupp‐Phelan
- Division of Emergency MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - David L. Schriger
- Department of Emergency MedicineUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | - Karl Sporer
- Division of Emergency MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Wilson MP, Hamrick E, Stiebel V, Nordstrom K. Contemporary Practices for Medical Evaluation of the Psychiatric Patient in the Emergency Department. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:28-34. [PMID: 37205042 PMCID: PMC10172537 DOI: 10.1176/appi.focus.20220063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although emergency department (ED) visits for patients with mental illness are frequent, medical evaluation (i.e., "medical screening") of patients presenting with psychiatric complaints is inconsistent. This may largely be related to differing goals for medical screening, which often vary according to specialty. Although emergency physicians typically focus on stabilization of life-threatening diseases, psychiatrists tend to believe that care in the ED is more comprehensive, which often places the two fields at odds. The authors discuss the concept of medical screening, review the literature on this topic, and offer a clinically oriented update to the 2017 American Association for Emergency Psychiatry consensus guidelines on medical evaluation of the adult psychiatric patient in the ED.
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Affiliation(s)
- Michael P Wilson
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Edward Hamrick
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Victor Stiebel
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
| | - Kimberly Nordstrom
- Department of Emergency Medicine and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (Wilson); Department of Psychiatry (Hamrick, Stiebel) and Department of Emergency Medicine (Stiebel), West Virginia University, Morgantown; Department of Psychiatry, University of Colorado Denver, Denver (Nordstrom)
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Grotts JH, Mead MM, Rab S, Walker IJ, Choi KR. Geospatial analysis of associations among mental health need, housing need, and involuntary psychiatric hospitalizations of people experiencing homelessness in Los Angeles County. Soc Sci Med 2022; 311:115343. [PMID: 36126473 DOI: 10.1016/j.socscimed.2022.115343] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/15/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to use geospatial indicators of mental health need and homelessness in Los Angeles County Service Planning Areas (SPAs) and a psychiatric sample of adults who were homeless to investigate 1) overlap between SPA level of mental health need and corresponding volume of involuntary psychiatric hospitalizations over time; 2) overlap between SPA level of unsheltered homelessness and corresponding volume of involuntary psychiatric hospitalizations over time; and 3) associations between SPA level of mental health need, SPA level of unsheltered homelessness, and initiation of a mental health conservatorship for grave disability. A sample of 373 adults who were homeless and hospitalized on an involuntary psychiatric hold from 2016 to 2018 were linked to data from the Greater Los Angeles Homeless Count on unsheltered homelessness and from the California Health Interview Survey on need for mental health services and suicidality, using admission zip codes to link variables at the SPA level. Geospatial mapping and bivariate tests were used to examine geographic overlap of SPA mental health need and unsheltered homelessness with volume of involuntary psychiatric admissions over the study period. Multiple logistic regression modeling was used to examine associations of SPA mental health need and unsheltered homelessness with conservatorship initiation. The volume of patients admitted from SPAs with higher levels of mental illness need grew from 2016 to 2018 (Tau = 0.27, P < 0.001; Tau = 0.40, P < 0.001), but there were fewer patients admitted from SPAs with higher levels of unsheltered homelessness over the same years (Tau of -0.33, P < 0.001). Being admitted from SPAs with the highest levels of unsheltered homelessness was associated with higher odds of conservatorship initiation (OR = 1.73, 95% CI = 1.82-16.74). Results suggest a need for targeted mental health and housing services to reach areas of highest need in Los Angeles County.
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Affiliation(s)
- Joseph H Grotts
- School of Nursing, UCLA; 700 Tiverton Ave Los Angeles, CA, 90049, USA
| | - Meredith M Mead
- Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA
| | - Shayan Rab
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Imani J Walker
- Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA
| | - Kristen R Choi
- School of Nursing, UCLA; 700 Tiverton Ave Los Angeles, CA, 90049, USA; Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA; Department of Health Policy & Management, Fielding School of Public Health, UCLA; 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA.
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Choi KR, Castillo EG, Seamans MJ, Grotts JH, Rab S, Kalofonos I, Mead M, Walker IJ, Starks SL. Mental Health Conservatorship Among Homeless People With Serious Mental Illness. Psychiatr Serv 2022; 73:613-619. [PMID: 34704772 PMCID: PMC9132544 DOI: 10.1176/appi.ps.202100254] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to examine associations between homelessness and length of psychiatric hospitalization and to explore the role of mental health conservatorship in determining discharge location for patients who are homeless and have a grave disability from serious mental illness. METHODS This observational study used administrative data from a safety-net psychiatric hospital in Los Angeles. The sample included 795 adults (≥18 years) who were hospitalized on an involuntary psychiatric hold between 2016 and 2018. The outcome variables were length of stay (days) and discharge location (home, locked psychiatric facility, unlocked psychiatric facility, unhoused). The predictor variables were homelessness status and whether a mental health conservatorship was initiated during hospitalization. Multiple regression models were used to estimate associations between variables. RESULTS Homelessness status was associated with 27.5 additional days (SE=3.5 days) of hospitalization in adjusted models. Homeless patients for whom conservatorship was initiated comprised 6% of the sample but 41% of total inpatient days. Among people who were homeless, initiation of a conservatorship was associated with significantly longer length of inpatient stay (mean=154.8 days versus 25.6 days for the whole sample) but also with lower odds of being unhoused at the time of discharge (risk ratio=0.19, 95% confidence interval=0.09-0.34). CONCLUSIONS A mental health conservatorship can be a mechanism for helping homeless people with a grave disability from mental illness to transition from the streets to residential psychiatric treatment, but it requires substantial resources from facilities that initiate such conservatorships and does not guarantee resolution of long-term supportive housing needs.
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Affiliation(s)
- Kristen R Choi
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Enrico G Castillo
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Marissa J Seamans
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Joseph H Grotts
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Shayan Rab
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Ippolytos Kalofonos
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Meredith Mead
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Imani J Walker
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
| | - Sarah L Starks
- School of Nursing, University of California, Los Angeles (UCLA) (Choi, Grotts); Department of Health Policy and Management (Choi) and Department of Epidemiology (Seamans), Fielding School of Public Health, UCLA; Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA (Castillo, Kalofonos, Starks); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA (Rab); Department of Psychiatry, West Los Angeles Veterans Affairs (VA) Medical Center (Kalofonos); Gateways Hospital and Mental Health Center (Mead, Walker); all in Los Angeles
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Abstract
OBJECTIVE Characterizing commitment as an involuntary psychiatric emergency detention that possibly extends into a longer-term detention, the authors aimed to calculate population rates of detentions and chart interstate differences since 2011 by means of publicly available state counts. METHODS Searches of state health and court websites yielded counts from 38 U.S. states. Usable counts from 25 states were classified as emergency or longer-term detentions and converted to crude rates per 100,000 people by using Census Bureau figures. RESULTS All-ages rates (per 100,000 people) of emergency detentions ranged from 29 in Connecticut to 966 in Florida. In 22 states with continuous 2012-2016 data, the average rate increased from 273 to 309. In four of five states with separate counts for adults and minors, rates over time for both were nearly parallel. In eight states that provided relevant data, the mean longer-term detention rate was 42% of a state's average emergency detention rate. Only one state provided length-of-stay data, and one counted both detentions and persons detained. In 24 states-accounting for 51.9% of the U.S. population-591,402 emergency involuntary detentions were recorded in 2014, the most recent year with most states reporting, a crude rate of 357 per 100,000. CONCLUSIONS Incidences of involuntary psychiatric detentions between 2011 and 2018 varied 33-fold across 25 states, and the mean state rate increased by three times the mean state population increase. Omissions in most states' counts clouded interpretation. More valid incidences obtained from standardized national data would improve analysis of the controversial yet opaque procedure of involuntary inpatient civil commitment.
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Affiliation(s)
- Gi Lee
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles
| | - David Cohen
- Department of Social Welfare, Luskin School of Public Affairs, University of California, Los Angeles
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Saunders J, Dongarwar D, Salemi J, Schulte J, Persse D, Matin A, Banu S, Shah A. Emergency mental health calls to first responders following a natural disaster: Examining the effects from Hurricane Harvey. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2021. [DOI: 10.4103/ijam.ijam_71_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Glomb NW, Grupp-Phelan J. A Call to Action to Address Disparities in Pediatric Mental Health Care. Pediatrics 2020; 146:peds.2020-018911. [PMID: 32963022 DOI: 10.1542/peds.2020-018911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Nicolaus W Glomb
- Department of Emergency Medicine, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Jacqueline Grupp-Phelan
- Department of Emergency Medicine, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
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Gonzalez K, Patel F, Cutchins LA, Kodish I, Uspal NG. Advocacy to Address Emergent Pediatric Mental Health Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Moskovitz J, Sapadin J, Guttenberg M. Interfacility ambulance transport of mental health patients. J Am Coll Emerg Physicians Open 2020; 1:173-182. [PMID: 33000032 PMCID: PMC7493513 DOI: 10.1002/emp2.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 11/21/2022] Open
Abstract
The transportation of mental health patients between facilities by emergency medical services personnel poses a unique risk to both patients and their providers. Increasingly, common injuries are occurring and difficulties are arising during this transition in care. Proximal causes exist that could be addressed to help mitigate many of the complexities that occur during this shift in care. Patient safety, quality of care, and provider safety are all at risk if improvements are not made and problems not identified or rectified.
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Affiliation(s)
- Joshua Moskovitz
- Albert Einstein College of MedicineBronxNew YorkUSA
- Hofstra School of Health and Human ServicesHempsteadNew YorkUSA
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Wang JY, Chang CC, Lee MC, Li YJ. Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis. BMC Health Serv Res 2020; 20:230. [PMID: 32188440 PMCID: PMC7081626 DOI: 10.1186/s12913-020-05089-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Abstract
Background The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization. Methods A total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4. Results PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05). Conclusion Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.
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Affiliation(s)
- Jong-Yi Wang
- Department of Health Services Administration, China Medical University, No. 91, Xueshi Rd., North Dist, Taichung City, 40402, Taiwan
| | - Cheng-Chen Chang
- Department of Psychiatry, Changhua Christian Hospital, 135 Nanxiao St., Changhua City, Changhua County, 50006, Taiwan
| | - Meng-Chen Lee
- Department of Medical Affairs, Landseed International Hospital, No. 77, Guangtai Rd., Pingzhen Dist, Taoyuan City, 32449, Taiwan
| | - Yi-Jhen Li
- Department of Health Services Policy and Management, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA.
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Fishe JN, Lynch S. Pediatric Behavioral Health-Related EMS Encounters: A Statewide Analysis. PREHOSP EMERG CARE 2019; 23:654-662. [PMID: 30612501 DOI: 10.1080/10903127.2019.1566423] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Pediatric behavioral health disorders and related emergency department visits are increasing, but effects on emergency medical services (EMS) are unknown. This study's objective was to describe the statewide epidemiology of pediatric behavioral health-related EMS encounters in Florida, including mental health and substance use. Methods: This analysis is a retrospective study of pediatric behavioral health-related EMS encounters from Florida's statewide EMS Tracking and Reporting Systems Database from 2011 to 2016. Demographic, clinical, EMS, and geographic characteristics are described. We also compared characteristics between patients who did and did not receive an acute EMS behavioral/psychiatric intervention. Results: There were 22,254 pediatric behavioral health-related EMS encounters during the study period, one-quarter of which were noted to have suspected or confirmed ingestion/substance use. The median age was 16 and the majority of patients were female and white. A total of 946 patients (4%) had an acute EMS behavioral/psychiatric intervention. EMS scene, ED turnaround, and total EMS time were significantly longer for intervention patients. Of the 14 counties in the top quartile of percentages of intervention patients, 7 were rural, 10 did not have any hospitals with child/adolescent psychiatric services, and 7 did not have any child psychiatrists. Conclusions: Pediatric behavioral-health related EMS encounters had a significant proportion of suspected ingestions/substance use, and we found disproportionate effects on rural agencies. Increases in EMS resource utilization (including longer EMS times) occurred in certain settings with limited behavioral health infrastructure. Those findings suggest an opportunity for community paramedicine to alleviate EMS utilization and decrease the frequency of pediatric behavioral health emergencies.
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