1
|
Karakus OB, Gamli IS, Yasoz C, Yildirim I, Adak I. Characteristics of children and adolescents with recurrent mental health emergency visits and clinicians' intervention tendencies. J Paediatr Child Health 2024. [PMID: 39385393 DOI: 10.1111/jpc.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/14/2024] [Accepted: 09/25/2024] [Indexed: 10/12/2024]
Abstract
AIM Mental disorders affect approximately 15%-20% of childhood. However, due to various factors, these individuals do not benefit sufficiently from mental health services. Therefore, psychiatry emergency services become a key system in the need of psychiatric care for these children. This study aims to reveal the factors that predict recurrent admissions in children and adolescents admitted to the emergency department of a psychiatric hospital and the tendencies of clinicians during management. METHODS In our study, the data of patients aged 0-18 years who applied to the emergency department between 1 March 2022 and 01 March 2023 were scanned retrospectively. Participants who applied once were included in the 'single applicant' group, whereas patients who applied two or more times were included in the 'repeated applicants' group. RESULTS A total of 1563 emergency applications were recorded by 785 different patients. A total of 62.2% of the patients visited the emergency department once, while 37.8% applied two or more times. Non-suicidal self-injury, delusion/hallucination, irritability and depression were significantly higher in recurrent applicants (P < 0.05). Psychotic disorder, bipolar disorder, major depression and borderline personality traits were significantly frequent in these patients (P < 0.05). Additionally, it was determined that the number of psychiatric diagnoses, referral time, need for chemical restraint, having a diagnosis of psychotic disorder or borderline personality traits increased the likelihood of recurrence. CONCLUSIONS Our results indicate some special risk factors that increase the likelihood of recurrent emergency admissions in children and adolescents. Further research with larger sample sizes may elucidate the unique needs of these children in order to use of community resources beneficially.
Collapse
Affiliation(s)
- Oguz Bilal Karakus
- Department of Child and Adolescent Psychiatry, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ipek Suzer Gamli
- Department of Child and Adolescent Psychiatry, Istanbul Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Cemre Yasoz
- Department of Child and Adolescent Psychiatry, Istanbul Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Irem Yildirim
- Department of Child and Adolescent Psychiatry, Istanbul Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Adak
- Department of Child and Adolescent Psychiatry, Istanbul Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Efron D, Fowler J, Cull E, Noakes K, Wilkin C, Haslam R. A novel model of care for paediatric patients with developmental disabilities and associated behaviours of concern. J Paediatr Child Health 2024. [PMID: 39014899 DOI: 10.1111/jpc.16615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/24/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
AIM Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self-injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re-presentation. METHODS We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan-do-study-act cycles. Re-presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post-enrolment to gather qualitative feedback about their experience of the model. RESULTS A total of 31 families participated in the study. Three- and 6-month re-presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards. CONCLUSIONS The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis-oriented help-seeking.
Collapse
Affiliation(s)
- Daryl Efron
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - James Fowler
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emily Cull
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kirsten Noakes
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Claire Wilkin
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ric Haslam
- Department of Mental Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Masserano B, Hall M, Wolf R, Diedrich A, Gupta A, Yu AG, Johnson K, Mittal V. Pharmacologic Restraint Use During Mental Health Admissions to Children's Hospitals. Pediatrics 2024; 153:e2023062784. [PMID: 38073316 DOI: 10.1542/peds.2023-062784] [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: 10/02/2023] [Indexed: 01/02/2024] Open
Abstract
OBJECTIVES Primary mental health admissions are increasing across US children's hospitals. These patients may experience agitation requiring pharmacologic restraint. This study characterized pharmacologic restraint use in medical inpatient units by primary mental health diagnosis. METHODS This retrospective, cross-sectional study used the Pediatric Health Information System database. The study included children aged 5 to 17 years admitted with a primary mental health diagnosis between 2016 and 2021. Rates of pharmacologic restraint use per 1000 patient days were determined for 13 mental health diagnoses and trended over time with Poisson regression. RESULTS Of 91 898 hospitalizations across 43 hospitals, 3% of admissions and 1.3% of patient days involved pharmacologic restraint. Trends in the rate of pharmacologic restraint use remained stable (95% confidence interval [CI], 0.7-2.1), whereas the incidence increased by 141%. Diagnoses with the highest rates of pharmacologic restraint days per 1000 patient days included autism (79.4; 95% CI, 56.2-112.3), substance-related disorders (45.0; 95% CI, 35.9-56.4), and disruptive disorders (44.8; 95% CI, 25.1-79.8). The restraint rate significantly increased in disruptive disorders (rate ratio [RR], 1.4; 95% CI, 1.1-1.6), bipolar disorders (RR, 2.0; 95% CI, 1.4-3.0), eating disorders (RR, 2.4; 95% CI, 1.5-3.9), and somatic disorders (RR, 4.2; 95% CI, 1.9-9.1). The rate significantly decreased for autism (RR, 0.8; 95% CI, 0.6-1.0) and anxiety disorders (RR, 0.3; 95% CI, 0.2-0.6). CONCLUSIONS Pharmacologic restraint use among children hospitalized with a primary mental health diagnosis increased in incidence and varied by diagnosis. Characterizing restraint rates and trends by diagnosis may help identify at-risk patients and guide targeted interventions to improve pharmacologic restraint utilization.
Collapse
Affiliation(s)
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Ryan Wolf
- Division of Hospital Medicine, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Andrew Diedrich
- Child and Adolescent Psychiatry, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
- Children's Medical Center, Dallas, Texas
| | - Ankita Gupta
- Divisions of Hospital Medicine
- Children's Medical Center, Dallas, Texas
| | - Andrew G Yu
- Divisions of Hospital Medicine
- Children's Medical Center, Dallas, Texas
| | - Katherine Johnson
- Divisions of Hospital Medicine
- Children's Medical Center, Dallas, Texas
| | - Vineeta Mittal
- Divisions of Hospital Medicine
- Children's Medical Center, Dallas, Texas
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Dalton EM, Worsley D, Krass P, Kovacs B, Raymond K, Feudtner C, Shea JA, Doupnik SK. Factors influencing agitation, de-escalation, and physical restraint at a children's hospital. J Hosp Med 2023; 18:693-702. [PMID: 37401165 PMCID: PMC10529788 DOI: 10.1002/jhm.13159] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Children hospitalized in medical hospitals are at risk of agitation. Physical restraint may be used to maintain patient and staff safety during de-escalation, but physical restraint use is associated with physical and psychological adverse events. OBJECTIVE We sought to better understand which work system factors help clinicians prevent patient agitation, improve de-escalation, and avoid physical restraint. DESIGN, SETTING, AND PARTICIPANTS We used directed content analysis to extend the Systems Engineering Initiative for Patient Safety model to clinicians working with children at risk for agitation at a freestanding children's hospital. INTERVENTION, MAIN OUTCOME, AND MEASURES We conducted semistructured interviews to examine how five clinician work system factors affected patient agitation, de-escalation, and restraint: person, environment, tasks, technology and tools, and organization. Interviews were recorded, transcribed, and analyzed until saturation. RESULTS Forty clinicians participated in this study, including 21 nurses, 15 psychiatric technicians, 2 pediatric physicians, 1 psychologist, and 1 behavior analyst. Work system factors that contributed to patient agitation were medical tasks like vital signs and the hospital environment including bright lights and neighboring patients' noises. Supports that helped clinicians de-escalate patients included adequate staffing and accessible toys and activities. Participants indicated that organizational factors were integral to team de-escalation, drawing connections between units' teamwork and communication cultures and their likelihood of successful de-escalation without the use of physical restraint. CONCLUSION Clinicians perceived that medical tasks, hospital environmental factors, clinician attributes, and team communication influenced patients' agitation, de-escalation, and physical restraint. These work system factors provide opportunities for future multi-disciplinary interventions to reduce physical restraint use.
Collapse
Affiliation(s)
- Evan M. Dalton
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
| | - Diana Worsley
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Polina Krass
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian Kovacs
- Department of Nursing and Clinical Care Services, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathleen Raymond
- Department of Nursing and Clinical Care Services, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A. Shea
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medical Ethics and Health Policy, Philadelphia, Pennsylvania, USA
| | - Stephanie K. Doupnik
- Division of General Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Clinical Futures and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Foster AA, Saidinejad M, Duffy S, Hoffmann JA, Goodman R, Monuteaux MC, Li J. Pediatric Agitation in the Emergency Department: A Survey of Pediatric Emergency Care Coordinators. Acad Pediatr 2023; 23:988-992. [PMID: 36948291 DOI: 10.1016/j.acap.2023.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE Acute agitation episodes in the emergency department (ED) can be distressing for patients, families, and staff and may lead to injuries. We aim to understand availability of ED resources to care for children with acute agitation, perceived staff confidence with agitation management, barriers to use of de-escalation techniques, and desired resources to enhance care. METHODS We conducted a survey of pediatric emergency care coordinators (PECCs) in EDs in Massachusetts, Rhode Island, and Los Angeles County, California. RESULTS PECCs from 63 of 102 (61.8%) EDs responded. PECCs reported that ED staff feel least confident managing agitation due to developmental delay (DD) or autism spectrum disorder (ASD) (52.4%). Few EDs had a separate space to care for children with mental health conditions (22.5%), a standardized agitation scale (9.6%), an agitation management guideline (12.9%), or agitation management training (24.2%). Modification of the environment was not perceived possible for 42% of EDs. Participants reported that a barrier to the use of the de-escalation techniques distraction and verbal de-escalation was perceived lack of effectiveness (22.6% and 22.6%, respectively). Desired resources to manage agitation included guidelines for medications (82.5%) and sample care pathways (57.1%). CONCLUSIONS ED PECCs report low confidence in managing agitation due to DD or ASD and limited pediatric resources to address acute agitation. Additional pediatric-specific resources and training, especially for children with DD or ASD, are needed to increase clinician confidence in agitation management and to promote high-quality, patient-centered care. Training programs can focus on the early identification of agitation and the effective use of non-invasive de-escalation strategies.
Collapse
Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine (AA Foster), University of California San Francisco, Calif.
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA (M Saidinejad and R Goodman), Torrance, Calif; David Geffen School of Medicine at UCLA (M Saidinejad), Los Angeles, Calif; Department of Emergency Medicine (M Saidinejad), Harbor UCLA Medical Center, Torrance, Calif.
| | - Susan Duffy
- Department of Emergency Medicine (S Duffy), The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
| | - Jennifer A Hoffmann
- Division of Emergency Medicine (JA Hoffmann), Ann & Robert H. Lurie Children...s Hospital of Chicago, Ill; Feinberg School of Medicine (JA Hoffmann), Northwestern University, Chicago, Ill.
| | - Robin Goodman
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA (M Saidinejad and R Goodman), Torrance, Calif.
| | - Michael C Monuteaux
- Division of Emergency Medicine (MC Monuteaux and J Li), Boston Children...s Hospital, Mass.
| | - Joyce Li
- Division of Emergency Medicine (MC Monuteaux and J Li), Boston Children...s Hospital, Mass; Department of Emergency Medicine (J Li), Harvard Medical School, Boston, Mass; Department of Pediatrics (J Li), Harvard Medical School, Boston, Mass.
| |
Collapse
|
10
|
Scheibe S, Luna IJ. Development of guidelines for hospital care of suicide attempts in adolescence. CIENCIA & SAUDE COLETIVA 2023; 28:863-874. [PMID: 36888869 DOI: 10.1590/1413-81232023283.10182022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 03/08/2023] Open
Abstract
This article aims to describe a qualitative and quantitative study of the construction and validation of guidelines for hospital care of adolescents with suicide attempts. The methodological approach involved an integrative literature review with thematic content analysis of 27 articles, which generated 3 categories: assessment of suicidal behavior in the context of the emergency department; intervention in suicidal behavior, and hospital multidisciplinary team. The content of these categories was the basis for the construction of an instrument with 15 statements about the performance of adolescents in suicidal crisis assisted in the hospital setting. This instrument was applied with 20 healthcare professionals selected from two hospital institutions in southern Brazil, who acted as judges/evaluators of the proposed statements. The content of the 15 statements was validated as guidelines through the Percentage of Concordance Calculation and the Score Calculation. The constructed guidelines may help multidisciplinary hospital teams when facing adolescents with suicide attempts, to base their conduct on criteria that guide actions of reception, assessment, intervention, and referral.
Collapse
Affiliation(s)
- Simone Scheibe
- Serviço de Psicologia, Hospital Infantil Joana de Gusmão. R. Rui Barbosa 152, Agronômica. 88025-301 Florianópolis SC Brasil.
| | - Ivânia Jann Luna
- Programa de Mestrado Profissional em Saúde Mental e Atenção Psicossocial, Departamento de Saúde Pública, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| |
Collapse
|
11
|
Scheibe S, Luna IJ. Development of guidelines for hospital care of suicide attempts in adolescence. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023283.10182022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract This article aims to describe a qualitative and quantitative study of the construction and validation of guidelines for hospital care of adolescents with suicide attempts. The methodological approach involved an integrative literature review with thematic content analysis of 27 articles, which generated 3 categories: assessment of suicidal behavior in the context of the emergency department; intervention in suicidal behavior, and hospital multidisciplinary team. The content of these categories was the basis for the construction of an instrument with 15 statements about the performance of adolescents in suicidal crisis assisted in the hospital setting. This instrument was applied with 20 healthcare professionals selected from two hospital institutions in southern Brazil, who acted as judges/evaluators of the proposed statements. The content of the 15 statements was validated as guidelines through the Percentage of Concordance Calculation and the Score Calculation. The constructed guidelines may help multidisciplinary hospital teams when facing adolescents with suicide attempts, to base their conduct on criteria that guide actions of reception, assessment, intervention, and referral.
Collapse
|
12
|
Gripko M, Joseph A, MohammadiGorji S. Effects of the physical environment on children and families in hospital-based emergency departments: A systematic literature review. JOURNAL OF ENVIRONMENTAL PSYCHOLOGY 2023; 86:101970. [PMID: 37366532 PMCID: PMC10292152 DOI: 10.1016/j.jenvp.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Every year, millions of children seek care in emergency departments (EDs) for various conditions. Though the physical environment of the ED provides the context and setting for care delivery, influences workflows, and shapes interactions between users, the noisy, sterile, stimulating nature of the ED can be counter-therapeutic to pediatric patients and families. This systematic literature review investigates this complex dynamic and asks how the physical environment of emergency departments affects children and their families or guardians. Using PRISMA methods, this review searched four databases to identify and analyze twenty-one peer-reviewed articles that explored the impacts of the physical environment of hospital-based EDs on children or family members. Several themes emerged from the literature - concerning control, positive distractions, family and social supports, and designing for a safe and comfortable experience - that illustrate opportunities for future ED design and highlight knowledge gaps and avenues for future research.
Collapse
Affiliation(s)
- Monica Gripko
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | | |
Collapse
|
13
|
Wolf RM, Hall M, Williams DJ, Carroll AR, Antoon JW, Brown CM, Herndon A, Kreth H, Lind C, Gastineau KAB, Spencer K, Ngo ML, Hart S, White L, Johnson DP. Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals. J Hosp Med 2023; 18:120-129. [PMID: 36415909 PMCID: PMC9899307 DOI: 10.1002/jhm.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/26/2022] [Accepted: 10/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use. OBJECTIVE To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. DESIGN, SETTING, AND PARTICIPANTS We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared. RESULTS Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis. CONCLUSIONS Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.
Collapse
Affiliation(s)
- Ryan M. Wolf
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew Hall
- Children’s Hospital Association, Lenexa, Kansas, USA
| | - Derek J. Williams
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison R. Carroll
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James W. Antoon
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charlotte M. Brown
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alison Herndon
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heather Kreth
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carrie Lind
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kelsey A. B. Gastineau
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katherine Spencer
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - My-Linh Ngo
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah Hart
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lindsay White
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David P. Johnson
- Department of Pediatrics, Monroe Carell Jr Children’s Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
14
|
Oblath R, Herrera CN, Were LPO, Syeda HS, Duncan A, Ferguson T, Kalesan B, Perez DC, Taglieri J, Borba CPC, Henderson DC. Long-Term Trends in Psychiatric Emergency Services Delivered by the Boston Emergency Services Team. Community Ment Health J 2023; 59:370-380. [PMID: 36001197 PMCID: PMC9399566 DOI: 10.1007/s10597-022-01015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Rising psychiatric emergency department (ED) presentations pose significant financial and administrative burdens to hospitals. Alternative psychiatric emergency services programs have the potential to alleviate this strain by diverting non-emergent mental health issues from EDs. This study explores one such program, the Boston Emergency Services Team (BEST), a multi-channel psychiatric emergency services provider intended for the publicly insured and uninsured population. BEST provides evaluation and treatment for psychiatric crises through specialized psychiatric EDs, a 24/7 hotline, psychiatric urgent care centers, and mobile crisis units. This retrospective review examines the sociodemographic and clinical characteristics of 225,198 BEST encounters (2005-2016). Of note, the proportion of encounters taking place in ED settings decreased significantly from 70 to 58% across the study period. Findings suggest that multi-focal, psychiatric emergency programs like BEST have the potential to reduce the burden of emergency mental health presentations and improve patient diversion to appropriate psychiatric care.
Collapse
Affiliation(s)
- Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, USA. .,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.
| | - Carolina N Herrera
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, USA
| | - Lawrence P O Were
- Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA.,Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Haniya Saleem Syeda
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tasha Ferguson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Bindu Kalesan
- Department of Medicine, Center for Clinical Translational Epidemiology and Comparative Effectiveness Research, Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, USA
| | - Daisy C Perez
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA
| | - Joan Taglieri
- Department of Psychiatry, Boston Medical Center, Boston, USA.,Department of Psychiatry, Cambridge Health Alliance, Cambridge, USA.,Boston University School of Medicine, Boston, USA
| | - Christina P C Borba
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - David C Henderson
- Department of Psychiatry, Boston Medical Center, Boston, USA.,BEST Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| |
Collapse
|
15
|
Chun A, Panchmatia R, Doan Q, Meckler G, Narayan B. Twitter as a Knowledge Translation Tool to Increase Awareness of the OpenHEARTSMAP Psychosocial Assessment and Management Tool in the Field of Pediatric Emergency Mental Health. Cureus 2022; 14:e27597. [PMID: 36059355 PMCID: PMC9433791 DOI: 10.7759/cureus.27597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale The increasing prevalence of pediatric mental health presentations in pediatric emergency departments (PED) requires improved integration of evidence-based management strategies. Social media, specifically Twitter, has shown potential to aid in closing the knowledge translation (KT) gap between these evidence-based management strategies and pediatric emergency medicine (PEM) providers. Aims and objectives The primary outcome of this study is to evaluate the effectiveness of Twitter as a KT dissemination tool in PEM. The exploratory outcomes were to assess how to effectively implement Twitter in KT, explore ways in which Twitter can maximize the global reach of OpenHEARTSMAP and whether Twitter can lead to increased adoption of OpenHEARTSMAP. Methods A one-week prospective promotion on Twitter was conducted to disseminate the OpenHEARTSMAP tool using 15 topic-related hashtags (arm 1, 15 Tweets) versus one post wherein 15 different Twitter users were mentioned in 15 different comments (arm 2, 1 Tweet). A one-week control period immediately prior to posting was employed for comparisons. Results During the Twitter week, visits per day to OpenHEARTSMAP increased by 175%; mean time spent on the website increased by 212%; and mean page actions per visit increased by 130%. The greatest increase in visits occurred on the first day of Tweeting. Arm 2 received the greatest engagements. Within arm 1, the category of pediatrics received the most engagements (hashtag #Peds was most popular). Arm 1 received 455 impressions compared to 2071 in arm 2. No new users registered an account on the OpenHEARTSMAP website, which is required to physically use the tool. Conclusion Twitter can be an effective KT tool to increase awareness of research, the first step of KT, in the domain of PEM mental health care. Strategies for success include building a robust Twitter following; posting during peak healthcare-related Twitter traffic times; employing hashtags coinciding with current events; and targeting posts by tagging users who need not necessarily be generally well-known opinion leaders.
Collapse
|
16
|
Walker N, Medlow S, Georges A, Steinbeck K, Ivers R, Perry L, Skinner SR, Kang M, Cullen P. Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review. Pediatr Emerg Care 2022; 38:342-350. [PMID: 34620805 DOI: 10.1097/pec.0000000000002551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. METHODS Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. RESULTS Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. CONCLUSIONS This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
Collapse
Affiliation(s)
| | | | | | | | | | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo
| | | | | | | |
Collapse
|
17
|
O'Donnell EP, Breden LE, Munjapara V, Ryan LM, Yanek L, Reynolds EK, Ngo T. Factors associated with a change in disposition for mental health patients boarding in an urban Paediatric emergency department. Early Interv Psychiatry 2022; 16:509-517. [PMID: 34268877 DOI: 10.1111/eip.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/10/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022]
Abstract
AIM Paediatric emergency departments (ED) nationwide experience a shared burden of boarding mental health patients. Whilst boarding, some patients have a change in disposition from hospitalization to discharge home. This phenomenon raises concern because EDs often have scarce resources for mental health patients. We sought to understand which patient and clinical factors are associated with a change in disposition outcome. METHODS A nested age-sex-race frequency-matched case-control study was conducted including paediatric patients who presented to an urban PED for mental healthcare over a 36-month period. Control patients included patients admitted to an inpatient psychiatric facility, whilst case patients were those discharged home. Descriptive statistics and multivariable logistic regression analyses were performed to compare groups. RESULTS Case patients were more likely to receive intramuscular Haloperidol (OR 2.2 [CI 1.1-4.4]) for agitation and a psychiatric consult (OR 2.3 [1.4-3.9]) whilst boarding. Case patients were also more likely to present with behavioural concerns (OR 1.8 [CI 1.1-3.1]) and have additional complexities such as medical comorbidities (OR 1.8 [CI 1.1-2.9]) or suicidal ideation/attempt (OR 2.6 [CI 1.1-6.1]). Amongst the most common themes for disposition change was improved patient status (58.8%). CONCLUSION These findings suggest that boarding mental health patients have different disposition outcomes and thus may benefit from patient-specific treatment interventions. Given that patients' statuses may change during the boarding period prompting discharge to home, more focus should be directed to developing brief evidence-based practises that may be implemented in the ED and effectively bridge the gap to outpatient mental health services.
Collapse
Affiliation(s)
- Erin P O'Donnell
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Larisa E Breden
- MD Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vasu Munjapara
- MD Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leticia M Ryan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa Yanek
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth K Reynolds
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thuy Ngo
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
18
|
Sensory-Friendly Emergency Department Visit for Patients with Autism Spectrum Disorder—A Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractOur goal was to develop non-pharmacologic strategies for addressing sensory challenges that patients with autism spectrum disorder (ASD) face in emergency departments (EDs). Search of five databases for articles written in English and published since 1980 returned 816 citations, of which 28 papers were selected for review. All studies were published in the last nine years, with 92.85% (n = 26) conducted in North America. We developed 26 consolidated strategies, encompassing five major domains, including guiding principles, care processes, people (behavior of staff members), objects, and places (facility design). Sensory-friendly care in ED requires an integrative approach and its success depends on guiding principles that tie various aspects of care and distinguishes ASD care from non-ASD care.
Collapse
|
19
|
Cree RA, So M, Franks J, Richards R, Leeb R, Hashikawa A, Krug S, Ludwig L, Olson LM. Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments. Pediatr Emerg Care 2021; 37:e1116-e1121. [PMID: 31738300 PMCID: PMC7217715 DOI: 10.1097/pec.0000000000001920] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. METHODS We analyzed data from the National Pediatric Readiness Project, a nationally representative cross-sectional survey of US EDs. Nurse managers reported whether their hospitals had a policy to care for children with social/mental health concerns (n = 3612). We calculated prevalence estimates, prevalence ratios (PRs), and confidence intervals (CIs) for regional and ED characteristics (eg, rurality and types of personnel) by whether EDs had a pediatric mental health care policy. RESULTS Overall, 46.2% (n = 1668/3612) of EDs had a pediatric mental health care policy. Emergency departments located in remote areas were 60% less likely to have such a policy compared with EDs in urban areas (PR, 0.4; CI, 0.3-0.5). Emergency department characteristics associated with having a pediatric mental health care policy included having a policy to transfer children with social/mental health concerns (PR, 5.4; CI, 4.7-6.2), having a policy to address maltreatment (PR, 3.4; CI, 2.6-4.4), and having nurse and physician pediatric emergency care coordinators (PR, 1.6; CI, 1.5-1.8). CONCLUSIONS Lower prevalence of pediatric mental health policies in rural EDs is concerning considering EDs are often the first point of contact for pediatric patients. This work highlights the importance of pediatric emergency care coordinators in fostering ED capacity to meet children's mental health needs.
Collapse
Affiliation(s)
- Robyn A. Cree
- Centers for Disease Control and Prevention, Division of Human Development and Disability, Atlanta, GA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marvin So
- Oak Ridge Institute for Science Education, Oak Ridge, TN
| | - Jessica Franks
- Oak Ridge Institute for Science Education, Oak Ridge, TN
| | - Rachel Richards
- University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT
| | - Rebecca Leeb
- Centers for Disease Control and Prevention, Division of Human Development and Disability, Atlanta, GA
| | - Andrew Hashikawa
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, MI
| | - Steven Krug
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lorah Ludwig
- Emergency Medical Services for Children, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Lenora M. Olson
- University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT
| |
Collapse
|
20
|
Foster AA, Sundberg M, Williams DN, Li J. Emergency department staff perceptions about the care of children with mental health conditions. Gen Hosp Psychiatry 2021; 73:78-83. [PMID: 34687946 DOI: 10.1016/j.genhosppsych.2021.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The number of children with mental health (MH) conditions who present to the emergency department (ED) is increasing. This study aimed to gain insight into the lived experiences of ED staff caring for children with MH conditions and to understand perceptions of current ED resources and what is needed to optimize care. METHODS This was a qualitative study informed by complexity science theory utilizing a phenomenological approach. We used purposeful sampling from urban and nonurban EDs with varying pediatric volume. Participants were pediatric emergency care coordinators and other ED staff. Semi-structured interviews were completed. The initial codebook was created using a concept driven approach. Constant comparative analysis and deductive reasoning was employed for thematic analysis. RESULTS Thematic saturation by consensus was achieved with 24 interviews. Analysis found an overarching theme of moral distress of ED staff, compounded by frustration with barriers to care and perceptions of negative impact on care of other ED patients. Participants suggested the need for creation of patient, caregiver, ED staff, and ED leadership resources to enhance care. CONCLUSIONS ED staff perceive children with MH conditions experience significant barriers to optimal care in the ED, which causes ED provider moral distress. Additionally, other ED patients are perceived to be subsequently negatively impacted. Our findings highlight urgency for funding for more resources that are dedicated to children in the ED setting to ensure both safe, patient-centered care, and to reduce the distress described by ED staff who care for them.
Collapse
Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Melissa Sundberg
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - David N Williams
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
| | - Joyce Li
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
| |
Collapse
|
21
|
Zanato S, Miscioscia M, Traverso A, Gatto M, Poli M, Raffagnato A, Gatta M. A Retrospective Study on the Factors Associated with Long-Stay Hospitalization in a Child Neuropsychiatry Unit. Healthcare (Basel) 2021; 9:1241. [PMID: 34575015 PMCID: PMC8465245 DOI: 10.3390/healthcare9091241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
The past twenty years have seen a rapid increase in acute psychiatric symptoms in children and adolescents, with a subsequent rise in the number of psychiatric hospitalizations. This paper aims to: (a) describe the epidemiology of hospitalizations and some of the clinical and sociodemographic characteristics of pediatric patients admitted to a regional referral Complex Operative Child Neuropsychiatry Hospital Unit in Northeast Italy and (b) identify potential factors correlated with the length of hospital stay. METHODS 318 (M = 12.8 years; SD = 3.11; 72% Female) patients hospitalized for mental health disorders from 2013 to 2019. RESULTS Around 60% of hospital admissions occurred via the emergency room, mostly due to suicidal ideation and/or suicide attempts (24%). Affective disorders were the most frequent discharge diagnosis (40%). As for factors correlated with length of hospital stay, we found significant links with chronological age, way of hospital admission, cause of admission, discharge diagnosis, presence of psychiatric comorbidity, family conflict, and psychiatric family history. CONCLUSIONS These results provide information about global characteristics associated with the length of psychiatric hospital stays in pediatric patients and provide a basis on which specific precautions can be hypothesized with the aim of developing more focused treatments.
Collapse
Affiliation(s)
- Silvia Zanato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Marina Miscioscia
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Annalisa Traverso
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Miriam Gatto
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Mikael Poli
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy; (M.G.); (M.P.)
| | - Alessia Raffagnato
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| | - Michela Gatta
- Child and Adolescent Neuropsychiatric Unit, Department of Women’s and Children’s Health, University Hospital of Padua, 35128 Padua, Italy; (S.Z.); (A.T.); (A.R.); (M.G.)
| |
Collapse
|
22
|
Hoffmann JA, Pergjika A, Konicek CE, Reynolds SL. Pharmacologic Management of Acute Agitation in Youth in the Emergency Department. Pediatr Emerg Care 2021; 37:417-422. [PMID: 34397677 PMCID: PMC8383287 DOI: 10.1097/pec.0000000000002510] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT When youth in the emergency department become acutely agitated, it can be dangerous and distressing to patients, families, and clinicians. Timely, effective, and patient-centered management is key to reducing the potential for patient and staff injury while preserving patient dignity. We review the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. We also discuss the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
Collapse
Affiliation(s)
- Jennifer A Hoffmann
- From the Attending Physician, Division of Emergency Medicine, Department of Pediatrics
| | - Alba Pergjika
- Attending Physician, Pritzker Department of Psychiatry and Behavioral Health
| | - Claire E Konicek
- Clinical Pharmacist, Department of Pharmacy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sally L Reynolds
- From the Attending Physician, Division of Emergency Medicine, Department of Pediatrics
| |
Collapse
|
23
|
Wilson E. Where next for youth mental health? Reflections on current research and considerations for the future. J Ment Health 2020; 29:371-375. [DOI: 10.1080/09638237.2020.1766001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Emma Wilson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| |
Collapse
|
24
|
Abstract
Higher level or acute psychiatric care for youth is intended to be active but short-term treatment focussing on crisis stabilisation, assessment, safety monitoring, and longer-term treatment planning. The focus of this article is on describing common challenges and the effort to address these challenges through new approaches to acute psychiatric care for children and adolescents. The review finds that (1) inpatient paediatric psychiatry beds are in high demand and often difficult to access, (2) there are a number of common challenges these units face including managing length of stays, readmissions, and adverse events, and (3) there are encouraging therapeutic approaches adapted for this setting. There is still much work to be done to advance the evidence-base for acute psychiatric care for youth particularly in defining and assessing an effective admission. Paediatric psychiatry patients are a vulnerable population and call for our best tools to be put to use to improve the quality and safety of care.
Collapse
Affiliation(s)
- Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Sasha Gorelik
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Kyle Kellermeyer
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
25
|
Outcome of pediatric emergency mental health visits: incidence and timing of suicide. CAN J EMERG MED 2020; 22:321-330. [PMID: 31955716 DOI: 10.1017/cem.2019.470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To determine the incidence, risk, and timing of mortality (unnatural and natural causes) among youth seen in a pediatric emergency department (ED) for mental health concerns, compared with matched non-mental health ED controls. METHODS This was a retrospective cohort study conducted at a quaternary pediatric ED in British Columbia. All visits for a mental health related condition between July 1st, 2005, and June 30th, 2015, were matched on age, sex, triage acuity, socioeconomic status, and year of visit to a non-mental health control visit. Mortality outcomes were obtained from vital statistics data through December 31st, 2016 (cumulative follow-up 74,390 person-years). RESULTS Among all cases in our study, including 6,210 youth seen for mental health concerns and 6,210 matched controls, a total of 13 died of suicide (7.5/100,000 person-years) and 33 died of suicide or indeterminate causes (44/100,000 person-years). All-cause mortality was significantly lower among mental health presentations (121.3/100,000 v. 214.5/100,000 person-years; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.37-0.78). The median time from initial emergency visit to suicide was 5.2 years (interquartile range, 4.2-7.3). Among mental health related visits, risk of death by suicide or indeterminate cause was three-fold that of matched controls (HR, 3.05 95%CI, 1.37-6.77). CONCLUSIONS While youth seeking emergency mental health care are at increased risk of death by unnatural causes, their overall mortality risk is lower than non-mental health controls. The protracted duration from initial presentation to suicide highlights the need for long-term surveillance and preventative care for youth seen in the ED for all mental health concerns.
Collapse
|
26
|
Koopmans E, Black T, Newton A, Dhugga G, Karduri N, Doan Q. Provincial dissemination of HEARTSMAP, an emergency department psychosocial assessment and disposition decision tool for children and youth. Paediatr Child Health 2019; 24:359-365. [PMID: 31528104 DOI: 10.1093/pch/pxz038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/19/2019] [Accepted: 03/02/2019] [Indexed: 01/20/2023] Open
Abstract
Background This article describes the provincial dissemination of HEARTSMAP, an evidence-based emergency department (ED) psychosocial assessment and disposition decision tool for clinician use with children and youth. Methods HEARTSMAP was disseminated in partnership with local, child and youth mental health teams, as part of a quality improvement initiative implemented in British Columbia EDs. The target audience of education sessions were clinicians working in ED settings responsible for paediatric psychosocial assessments. We used the RE-AIM framework to evaluate the reach, effectiveness, adoption, implementation, and maintenance of HEARTSMAP dissemination, analyzing data from session evaluation forms and online tool data. Results Education sessions reached 475 attendees, in 52 of 95 British Columbia EDs. HEARTSMAP training was well received by clinicians with 96% describing effective content including increased comfort in conducting paediatric psychosocial assessments and confidence in disposition planning after training. Clinicians identified unclear processes and lack of local resources as the main barriers to implementation. One-third of the attendees expressed willingness to use the tool, and 27% of registered clinicians have used the tool postimplementation. Conclusions Our approach reached and effectively trained clinicians from over half of the province's EDs to use HEARTSMAP for emergency paediatric psychosocial assessments. For some, this provided greater comfort and confidence for these assessments and the following disposition decisions. This evaluation provides valuable insights on training clinicians to use a paediatric mental health tool within diverse ED settings and emphasized the need for ongoing support and institutional engagement to facilitate local, infrastructural, and operational processes for adoption and maintenance, postdissemination.
Collapse
Affiliation(s)
- Erica Koopmans
- BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Amanda Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Gurm Dhugga
- BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Naveen Karduri
- BC Children's Hospital Research Institute, Vancouver, British Columbia
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia.,BC Children's Hospital Research Institute, Vancouver, British Columbia
| |
Collapse
|
27
|
Santillanes G, Rowland K, Demarest M, Lam CN, Wilson MP, Claudius I, Menchine M. Discontinuing involuntary mental health holds for children: Does psychiatrist specialty matter? A pilot study. Am J Emerg Med 2019; 38:702-708. [PMID: 31204151 DOI: 10.1016/j.ajem.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Involuntary mental health detainments should only be utilized when less restrictive alternatives are unavailable and should be discontinued as soon as safety can be ensured. The study objective was to determine if child and adolescent psychiatrists discontinue a greater proportion of involuntary holds than general psychiatrists for similar pediatric patients. METHODS Retrospective analysis of consecutive patients under 18 years placed on an involuntary hold in the prehospital setting presenting over a 1-year period to one high-volume emergency department (ED) where youth on involuntary holds are seen by child and adolescent psychiatrists when available and general psychiatrists otherwise. The primary outcome of interest was hold discontinuation after initial psychiatric consultation. The key predictor of interest was psychiatrist specialty (child and adolescent vs. general). We conducted multivariate logistic regression modeling adjusting for patient characteristics and time of arrival. RESULTS Child and adolescent psychiatrists discontinued 27.4% (51/186) of prehospital holds while general psychiatrists discontinued only 10.6% (22/207). After adjusting for observable confounders, holds were over 3 times as likely to be discontinued in patients evaluated by child and adolescent psychiatrists rather than general emergency psychiatrists (adjusted OR 3.2, 95% CI 1.7-5.9, p < 0.001). CONCLUSIONS Child and adolescent psychiatrists are much more likely to discontinue prehospital involuntary mental health holds compared with general emergency psychiatrists. While inappropriate hold discontinuation places patients at risk of harm, prolonged hold continuation limits patients' rights and potentially increases psychiatric boarding in EDs. Earlier access to child and adolescent psychiatry may facilitate early hold discontinuation and standardize patient care.
Collapse
Affiliation(s)
- Genevieve Santillanes
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Kathleen Rowland
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Matthew Demarest
- Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America.
| | - Michael P Wilson
- Department of Emergency Medicine Behavioral Emergencies Research Lab and Department of Emergency Medicine, University of Arkansas for Medical Sciences, 4395 Shuffield Dr., Little Rock, AR 72205, United States of America.
| | - Ilene Claudius
- Harbor-UCLA Medical Center, 1000 W Carson Street, Torrance, CA 90509, United States of America
| | - Michael Menchine
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N. State Street, GNH 1011, Los Angeles, CA 90033, United States of America; Leonard D. Schaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, 635 Downey Way Verna & Peter Dauterive Hall (VPD), Los Angeles, CA 90089, United States of America
| |
Collapse
|
28
|
Leon SL, Polihronis C, Cloutier P, Zemek R, Newton AS, Gray C, Cappelli M. Family Factors and Repeat Pediatric Emergency Department Visits for Mental Health: A Retrospective Cohort Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:9-20. [PMID: 31001347 PMCID: PMC6457444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Approximately 45% of youth presenting to the emergency department (ED) for mental health (MH) concerns will have a repeat ED visit. Since youth greatly depend on their caregivers to access MH services, the objective of this study was to determine if family characteristics were associated with repeat ED visits. METHODS A retrospective cohort study of youth aged 6-18 years (62% female) treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Family factor contribution was analyzed using a multivariable logistic regression model controlling for demographic, clinical and service utilization factors. Variables associated with earlier and more frequent visits were determined using cox regression and negative binomial regression. RESULTS Of 266 participants, 70 (26%) had a repeat visit. While caregiver history of MH treatment decreased the odds of having a repeat ED visit, family functioning and perceived family burden were not associated with repeat visits. Post-visit MH services, prior psychiatric hospitalization, higher severity of symptoms, and living closer to the hospital increased the odds of repeat visits. CONCLUSIONS This study examined the contribution of multiple family factors in predicting repeat MH visits to the ED. Results suggest caregiver characteristics may impact the decision to return. Healthcare providers should therefore consider caregiver and youth service utilization factors to inform patient management and discharge planning.
Collapse
Affiliation(s)
- Stephanie L Leon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario
| | | | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Medicine, Department of Pediatrics, Ottawa, Ontario
| | - Amanda S Newton
- University of Alberta, Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, Alberta
| | - Clare Gray
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Graduate and Postdoctoral Studies, Ottawa, Ontario
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario
| |
Collapse
|
29
|
Dombagolla MH, Kant JA, Lai FW, Hendarto A, Taylor DM. Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management). Australas Emerg Care 2019; 22:8-12. [DOI: 10.1016/j.auec.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/17/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
|
30
|
Gill C, Arnold B, Nugent S, Rajwani A, Xu M, Black T, Doan Q. Reliability of HEARTSMAP as a Tool for Evaluating Psychosocial Assessment Documentation Practices in Emergency Departments for Pediatric Mental Health Complaints. Acad Emerg Med 2018; 25:1375-1384. [PMID: 29924893 DOI: 10.1111/acem.13506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/01/2018] [Accepted: 06/18/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The goal of this study was to assess the reliability of HEARTSMAP as a standardized tool for evaluating the quality of psychosocial assessment documentation of pediatric mental health (MH) presentations to the emergency department (ED). In addition, we report on current documentation practices. METHODS We conducted a retrospective cross-sectional study of pediatric (up to age 17) MH-related visits to four EDs between April 1, 2013, and March 31, 2014. The primary outcome was the inter-rater agreement when evaluating the completeness of pediatric emergency psychosocial assessments using the HEARTSMAP tool. The secondary outcome was to describe the adequacy of documentation of emergency pediatric MH assessments, using HEARTSMAP as a guide for a complete assessment. RESULTS A total of 400 medical records (100 from each site) were reviewed. We observed near-perfect inter-rater agreement (κ = 0.99-1.00) regarding the presence of documentation and good-to-perfect agreement (κ = 0.71-1.00) regarding whether sufficient information was documented to score a severity level for every component of an emergency psychosocial assessment. Inter-rater agreement regarding whether referrals or resources were documented for identified needs was observed to be good to very good (κ = 0.62-0.98). Current psychosocial documentation practices were found to be inconsistent with significant variability in the presence of documentation pertaining to HEARTSMAP sections between medical centers and initial clinician assessor and whether specialized MH services were involved prior to discharge. CONCLUSIONS The HEARTSMAP tool can be reliably used to assess pediatric psychosocial assessment documentation across a diverse range of EDs. Current documentation practices are variable and often inadequate, and the HEARTSMAP tool can aid in quality improvement initiatives to standardize and optimize care for the growing burden of pediatric mental illness.
Collapse
Affiliation(s)
- Carson Gill
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brendan Arnold
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Nugent
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alykhan Rajwani
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Xu
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Black
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
31
|
Haidar-Elatrache S, Wolf M, Fabie NAV, Sahai S. Approach to Children with Aggressive Behavior for General Pediatricians and Hospitalists: Part 2-Evaluation, Tests, and Treatment. Pediatr Ann 2018; 47:e408-e412. [PMID: 30308677 DOI: 10.3928/19382359-20180919-02] [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] [Indexed: 11/20/2022]
Abstract
After reviewing the various etiologies that can contribute to a presentation of aggressive behavior in a child (see part 1), a physician should conduct a thorough history and physical examination. The history should be obtained from the patient and caregivers, both together and separately in adolescents. A good physical examination starts with assessment and interpretation of vital signs, followed by a head-to-toe examination focusing on the skin, eyes, and thyroid, and then a neurologic examination. The testing and observation should be tailored to the individual patient, including laboratory results, imaging, and specialist consultation. Management of aggressive behavior can often be achieved through a combination of environmental modifications and verbal techniques, with special consideration given to children with neurodevelopmental problems such as autism. Pharmacologic agents are a good next step, and physical restraints can be used as a last resort. Evaluation of suicidality with thorough and complete questioning as well as assessment of a safety plan can aid in determining patient disposition such as need for admission to a psychiatric facility. [Pediatr Ann. 2018;47(10):e408-e412.].
Collapse
|
32
|
Abstract
Mental illness among children and adolescents is an increasing burden, projected to become one of the world's leading disabilities in near future. A dearth of specialized services and personnel to provide optimal care affects the disease burden, prevalence, health care services, and health care costs. The increasing demand weighs down on generalized systems of care such as emergency department (ED) services, in which the lack of specific training, personnel, and specialized protocols tends to prolong length of stay, recidivism, and suboptimal care. This article reviews outcomes and trends of overburdened ED systems in the context of pediatric mental health care management, guidelines of care, and strategies to manage common pediatric mental health emergencies and expand services within the ED. [Pediatr Ann. 2018;47(8):e328-e333.].
Collapse
|
33
|
Lelonek G, Crook D, Tully M, Trufelli K, Blitz L, Rogers SC. Multidisciplinary Approach to Enhancing Safety and Care for Pediatric Behavioral Health Patients in Acute Medical Settings. Child Adolesc Psychiatr Clin N Am 2018; 27:491-500. [PMID: 29933797 DOI: 10.1016/j.chc.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Emergency department visits by pediatric behavioral health patients are increasing, increasing the complexity of care. This article describes initiatives at 3 academic medical centers using multidisciplinary teams, including medical, child life, and security staff, to help decrease anxiety and increase patient comfort. Training in Dialectical Behavior Therapy and agitation management simulations increase staff preparedness for working with agitated and emotionally dysregulated patients. Training security personnel and establishing a behavioral health response team ensures that staff members with expertise in managing agitation support the medical teams and patients throughout the hospital.
Collapse
Affiliation(s)
- Gary Lelonek
- Cohen Children's Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Douglas Crook
- Behavioral Response Team, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Maura Tully
- Child Life Department, Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Kristen Trufelli
- Behavioral Health Urgent Care Center, Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Lindsay Blitz
- Emergency Department, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Steven C Rogers
- Division of Emergency Medicine, Emergency Mental Health Services, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| |
Collapse
|
34
|
Roberts N, Nesdole R, Hu T. Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:33-38. [PMID: 29375631 PMCID: PMC5777689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. METHOD This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. RESULTS Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p < 0.01), a higher proportion in special educational placement (X2 (1) = 6.82, p < 0.01), a higher proportion with a family history of anxiety disorders (X2 (1) = 10.62, p = 0.01) and substance use disorder (X2 (1) = 18.99, p < 0.01). Conditional logistic regression results suggested that repeat-presentation group had higher odds of past hospital admission (OR: 3.50, p < 0.01) higher odds of family history of mood disorders (OR: 4.86, p < 0.01) and of antisocial disorders (OR: 4.97, p = 0.02), and lower odds of recommendation compliance (OR: 0.10, p < 0.01). CONCLUSION Repeat-presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.
Collapse
Affiliation(s)
- Nasreen Roberts
- Child and Adolescent Mental Health Urgent Consult Clinic, Department of Psychiatry, Queen’s University, Kingston, Ontario
| | - Robert Nesdole
- Department of Psychiatry Queen’s University, Kingston, Ontario
| | - Tina Hu
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| |
Collapse
|
35
|
Cohen L, Gras-Le Guen C, Fleury J, Caldagues E, Dreno L, Picherot G, Vabres N. Agitation des adolescents dans les services d’accueil des urgences pédiatriques : problématique des cas dits « complexes ». Arch Pediatr 2017; 24:1214-1219. [DOI: 10.1016/j.arcped.2017.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/06/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
|
36
|
Asarnow JR, Babeva K, Horstmann E. The Emergency Department: Challenges and Opportunities for Suicide Prevention. Child Adolesc Psychiatr Clin N Am 2017; 26:771-783. [PMID: 28916013 PMCID: PMC6768433 DOI: 10.1016/j.chc.2017.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Emergency departments (EDs) can offer life-saving suicide prevention care. This article focuses on the ED and emergency services as service delivery sites for suicide prevention. Characteristics of EDs, models of emergency care, ED screening and brief intervention models, and practice guidelines and parameters are reviewed. A care process model for youths at risk for suicide and self-harm is presented, with guidance for clinicians based on the scientific evidence. Strengthening emergency infrastructure and integrating effective suicide prevention strategies derived from scientific research are critical for advancing suicide prevention objectives.
Collapse
Affiliation(s)
- Joan Rosenbaum Asarnow
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA.
| | - Kalina Babeva
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA
| | - Elizabeth Horstmann
- David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, 300 Medical Plaza, Suite 3310, Los Angeles, CA 90095, USA
| |
Collapse
|
37
|
Leon SL, Cloutier P, Polihronis C, Zemek R, Newton AS, Gray C, Cappelli M. Child and Adolescent Mental Health Repeat Visits to the Emergency Department: A Systematic Review. Hosp Pediatr 2017; 7:177-186. [PMID: 28196831 DOI: 10.1542/hpeds.2016-0120] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Repeat visits represent up to 45% of mental health (MH) presentations to emergency departments (EDs) and are associated with higher health care costs. We aimed to synthesize available literature on predictors of pediatric MH repeat ED visits and differences between repeat visitors and nonrepeat visitors. METHODS A systematic review was performed using PsycINFO, PubMed, and CINAHL databases. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist. Methodologic quality was assessed using the following 8 criteria: design, generalizability, breadth of predictors, reporting of effect sizes, additional outcomes, interaction terms, confounding variables, and clear definition of repeat visits. RESULTS A total of 178 articles were retrieved; 11 articles met inclusion criteria. Quality assessment revealed that all studies used chart review or administrative data. Predictors were grouped into 3 categories: demographic, clinical, and MH care access and utilization factors. Common predictors associated with repeat ED MH visits included socioeconomic status, involvement with child protective services, and previous and current MH service use. For studies using a 6-month repeat window, the most common factors were previous psychiatric hospitalization and currently receiving MH services. Heterogeneity in statistical analyses and determinants explored precluded the use of meta-analysis. CONCLUSIONS Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. To further elucidate the strongest predictors, future prospective research should consider prospective designs and include family factors. Investigating recency and frequency outcomes can also inform clinical practice.
Collapse
Affiliation(s)
- Stephanie L Leon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Faculty of Social Sciences, School of Psychology, and
| | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christine Polihronis
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychology, Carleton University, Ottawa, Ontario, Canada; and
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Clare Gray
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; .,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Faculty of Graduate and Postdoctoral Studies, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
38
|
Zanus C, Battistutta S, Aliverti R, Montico M, Cremaschi S, Ronfani L, Monasta L, Carrozzi M. Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors. PLoS One 2017; 12:e0170979. [PMID: 28125701 PMCID: PMC5268645 DOI: 10.1371/journal.pone.0170979] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/13/2017] [Indexed: 12/23/2022] Open
Abstract
The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.
Collapse
Affiliation(s)
- Caterina Zanus
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Sara Battistutta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Renata Aliverti
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Silvana Cremaschi
- Child and Adolescent Neuropsychiatry Service, ASS4 Medio Friuli, Udine, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
| | - Marco Carrozzi
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| |
Collapse
|
39
|
Predictors of Repeated Visits to a Pediatric Emergency Department Crisis Intervention Program. CAN J EMERG MED 2016; 19:122-130. [PMID: 27573354 DOI: 10.1017/cem.2016.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Despite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits. METHODS We examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression. RESULTS A total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances. CONCLUSIONS Repeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.
Collapse
|
40
|
Carubia B, Becker A, Levine BH. Child Psychiatric Emergencies: Updates on Trends, Clinical Care, and Practice Challenges. Curr Psychiatry Rep 2016; 18:41. [PMID: 26932516 DOI: 10.1007/s11920-016-0670-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Over the past 15 years, the number of pediatric patients presenting to the emergency room in psychiatric crisis has nearly doubled. Suicidality and aggression are among the most common presenting problems, making it important for providers to have up-to-date knowledge about the assessment and management of these frequently encountered clinical issues. Psychometrically sound suicide risk assessment tools are available for use in the emergency room setting, which can be administered efficiently with minimal provider training. Rates of off-label medication use in the pediatric population continue to increase and are often used in the management of acute agitation in the pediatric population. The current literature will be reviewed and summarized for application in emergent treatment settings. Overall, evidence to inform best practice is limited, leading to opportunities for innovation in health care delivery, the development of new research aims, and discussion of challenging clinical dilemmas.
Collapse
Affiliation(s)
- Beau Carubia
- Department of Psychiatry, University of Colorado, Aurora, CO, USA. .,B. Harrison Levine, MD, Inc., Denver, CO, USA.
| | - Amy Becker
- Department of Psychiatry, University of Colorado, Aurora, CO, USA.,Psychiatric Emergency Service, Children's Hospital Colorado, Aurora, CO, USA
| | | |
Collapse
|
41
|
McCaskill ME, Durheim E. Managing adolescent behavioural and mental health problems in the Emergency Department. J Paediatr Child Health 2016; 52:241-5. [PMID: 27062631 DOI: 10.1111/jpc.13104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/02/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022]
Abstract
Children and young people with behavioural issues frequently present to Emergency Departments. These are complex cases, often with a long preceding history. Caring for them requires a structured approach to ensure safety for the patient and all those involved. The HEADSS assessment is used as a framework. The Emergency Department focuses on treatment of the acute behavioural issues in the least restrictive manner possible. Ongoing behavioural issues are managed with referral to community and specialist resources.
Collapse
Affiliation(s)
- Mary E McCaskill
- Emergency Department, The Children's Hospital at Westmead, Westmead, Australia
| | - Earle Durheim
- Emergency Department, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
42
|
Esmailian M, Ahmadi O, Taheri M, Zamani M. Comparison of haloperidol and midazolam in restless management of patients referred to the Emergency Department: A double-blinded, randomized clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:844-9. [PMID: 26759570 PMCID: PMC4696368 DOI: 10.4103/1735-1995.170598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Restless and violent behaviors are common in Emergency Departments (EDs), which need therapeutic interventions in most of the times. The first-generation anti-psychotic drugs are one of the most applicable therapeutic agents in the management of such patients, but their use has some limitations. Some studies suggest midazolam as an alternative medicine. Therefore, this study was performed with the aim of comparison of the efficacy and safety of haloperidol and midazolam in the restless management of referring patients to EDs. Materials and Methods: The present double-blinded trial was done on patients needed sedation and referred to the ED of Alzahra Hospital, Isfahan, Iran, in 2014. The patients were categorized into two random groups of haloperidol (5 mg) and midazolam receivers (2.5 mg for those weighing <50 kg and 5 mg in >50 kg), as intramuscular administration. The time to achieve sedation, need for rescue dose, need to resedation within the first 60 min, and adverse effects of drugs were compared among the groups. Results: Forty-eight patients were entered to the study. The mean age in the haloperidol and midazolam groups was 44.8 ± 4.1 years and 45.5 ± 4.7 years, respectively (P = 0.91). The mean time of sedation in the haloperidol and midazolam groups was 5.6 ± 0.3 min and 5.2 ± 0.1 min, respectively (P = 0.31). The mean time of full consciousness after sedation was 36.2 ± 4.5 min and 38.2 ± 3.4 min in the haloperidol and midazolam groups, respectively (P = 0.72). On average, time to arousal in the midazolam group was 10.33 min more than the haloperidol group, but it was not statistically significant. Conclusion: The results of the present study show that administration of midazolam and haloperidol have similar efficacy in the treatment of restless symptoms with the same recovery time from drug effects for referring patients to the ED. In addition, none of the adverse effects were observed in this study.
Collapse
Affiliation(s)
- Mehrdad Esmailian
- Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Ahmadi
- Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrsa Taheri
- Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Zamani
- Department of Emergency Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
43
|
|