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Mao W, Shalaby R, Agyapong VIO. Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare (Basel) 2023; 11:healthcare11081161. [PMID: 37107995 PMCID: PMC10138571 DOI: 10.3390/healthcare11081161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. OBJECT This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. METHOD The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. RESULT This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. CONCLUSION Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans, Memorial Lane, 8th Floor Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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Özlü-Erkilic Z, Diehm R, Wenzel T, Bingöl Ҫağlayan RH, Güneş H, Üneri ÖŞ, Winter S, Akkaya-Kalayci T. Transcultural differences in suicide attempts among children and adolescents with and without migration background, a multicentre study: in Vienna, Berlin, Istanbul. Eur Child Adolesc Psychiatry 2022; 31:1671-1683. [PMID: 34050830 PMCID: PMC9666344 DOI: 10.1007/s00787-021-01805-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
While suicide can occur throughout the lifespan, worldwide suicide is the second leading cause of death among young people aged between 15 and 29 years. The aim of this multicentre study, conducted in Austria, Germany and Turkey, is to investigate the transcultural differences of suicide attempts among children and adolescents with and without migration background. The present study is a retrospective analyses of the records of 247 young people, who were admitted after a suicide attempt to Emergency Outpatient Clinics of Departments of Child and Adolescent Psychiatry of the collaborating Universities including Medical University of Vienna, Charité University Medicine Berlin and Cerrahpaşa School of Medicine and Bakirkoy Training and Research Hospital for Mental Health in Istanbul over a 3-year period. The results of the present study show significant transcultural differences between minors with and without migration background in regard to triggering reasons, method of suicide attempts and psychiatric diagnosis. The trigger event "intra-familial conflicts" and the use of "low-risk methods" for their suicide attempt were more frequent among patients with migration background. Moreover among native parents living in Vienna and Berlin divorce of parents were more frequent compared to parents living in Istanbul and migrants in Vienna. These results can be partly explained by cultural differences between migrants and host society. Also disadvantages in socio-economic situations of migrants and their poorer access to the healthcare system can mostly lead to acute and delayed treatments. Larger longitudinal studies are needed to understand better the impact of migration on the suicidal behaviour of young people.
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Affiliation(s)
- Zeliha Özlü-Erkilic
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert Diehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Wenzel
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - R Hülya Bingöl Ҫağlayan
- Department of Child and Adolescents Psychiatry, Cerrahpaşa School of Medicine, İstanbul University-Cerrahpaşa, Kocamustafapasa Cd. No: 53, Fatih, Istanbul, Turkey
| | - Hatice Güneş
- Department of Psychology, İstanbul Gelisim University, Cihangir Mahallesi Şehit Jandarma Komando Er Hakan Oner Sk. No:1, Avcilar, Istanbul, Turkey
- Department of Child and Adolescent Psychiatry, Bakirkoy Training and Research Hospital for Mental Health and Neurological Disorders, Zuhuratbaba Mah. Dr Tevfik Sağlam Cad. No:25/2, Bakirköy, Istanbul, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescents Psychiatry, Ankara City Hospital, AYBÜ Ankara Şehir Hastanesi Çocuk Hastanesi 06800 Bilkent, Ankara, Turkey
| | - Sibylle Winter
- Departement of Child and Adolescent Psychiatry, Psychsomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenbruger Platz 1, 13353, Berlin, Germany
| | - Türkan Akkaya-Kalayci
- Department of Child and Adolescent Psychiatry, Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Postgraduate University Program Transcultural Medicine and Diversity Care, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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Lee A, Davidson J, Black T, Kim GG, Doan Q. Youth mental health-related presentations at a quaternary centre: Who comes, What are their needs, and Can we meet their needs. Paediatr Child Health 2022; 27:147-153. [PMID: 35712040 PMCID: PMC9191912 DOI: 10.1093/pch/pxab091] [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: 06/17/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Mental health issues are increasingly prevalent across Canada, reflected in rising presentations to emergency departments. To effectively address the needs of children and youth seeking mental health-related care in the emergency department and to judiciously use scarce mental health-related resources, we need to better identify the specific areas of psychosocial needs and accessibility of associated services. Objective To describe the types and severity of paediatric mental health-related presentations evaluated at a quaternary paediatric emergency department, and to explore the accessibility of community mental health-related resources. Methods We conducted a retrospective cohort study of children and youth presenting to a quaternary paediatric emergency department who were assessed using HEARTSMAP, a validated mental health assessment and management tool. We reported the proportion who sought care for a psychiatric, social, or youth health-related mental health complaint. We contacted community mental health-related resources for their estimated wait times to determine accessibility. Results Of 1,530 paediatric emergency presentations, 98.8% of patients had psychiatric issues (40.1% were severe), 78.0% of patients had social issues (17.1% were severe), and 71.5% had youth health issues (18.1% were severe). We contacted 123 community mental health-related resources. Community youth health and social services were somewhat accessible, with 50.0% and 38.7%, respectively, able to intake youth within a week of referral. Community psychiatric programs were least accessible, with 59.3% having wait times greater than 1 month. Conclusions Many psychiatric concerns presenting in paediatric emergency departments have complex psychosocial challenges requiring non-psychiatric support. A need exists for improved accessibility to community psychiatric programs.
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Affiliation(s)
- Alison Lee
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jana Davidson
- Department of Psychiatry., BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler Black
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Grace G Kim
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Quynh Doan
- Correspondence: Quynh Doan, Division of Pediatric Emergency Medicine, Department of Pediatrics, UBC, BC Children’s Hospital Research Institute., Emergency Department, 4480 Oak Street office B429, Vancouver, British Columbia, V6H 3N1, Canada. Telephone (778)-984-9914, fax (604)-875-2366, e-mail
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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.
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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
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Randall MM, Parlette K, Reibling E, Chen B, Chen M, Randall F, Brown L. Young children with psychiatric complaints in the pediatric emergency department. Am J Emerg Med 2020; 46:344-348. [PMID: 33059988 DOI: 10.1016/j.ajem.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children are increasingly diagnosed with mental illnesses and self-harm behaviors. They present frequently to the emergency department (ED) for evaluation. The aim of this study is to describe the youngest children in the ED with psychiatric issues. METHODS This is a retrospective chart review of all consecutive children less than 10 years of age with a psychiatric complaint who received a psychiatric consultation in the pediatric emergency department in the last four years. RESULTS The number of children with psychiatric issues increased over the study period. The ED length of stay also increased. Violent behavior and aggression were the most common chief complaints, and some children required chemical or physical restraint in the ED. Many children had pre-existing psychiatric issues and a history of adverse childhood experiences. Half of patients were deemed safe for discharge home by psychiatric consultation. CONCLUSION The number of young children with psychiatric complaints presenting to the ED has increased. However, a large number are found to be stable for discharge home. Increase in urgent outpatient psychiatric resources could help decrease ED utilization.
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Affiliation(s)
- Melanie M Randall
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Karli Parlette
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Ellen Reibling
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Brian Chen
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Miryah Chen
- Pediatrics Department, Kaiser Permanente Medical Group Moreno Valley, 12815 Heacock St, Moreno Valley, CA 92553, USA
| | - Frank Randall
- Psychiatry Department, Kaiser Permanente Medical Group Fontana, 1301 California St, Redlands, CA 92374, USA
| | - Lance Brown
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
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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.
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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
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Gay A, Peyrard M, Pineau P, Pellet J, Trombert-Paviot B, Massoubre C. Risk factors for return visits and rehospitalizations to the child emergency psychiatric unit: A retrospective study over 2 years at Saint-Étienne University Hospital. Encephale 2019; 45:468-473. [DOI: 10.1016/j.encep.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 10/26/2022]
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Lynch S, Pines J, Mutter R, Teich JL, Hendry P. Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers. SOCIAL WORK IN HEALTH CARE 2019; 58:807-824. [PMID: 31422764 DOI: 10.1080/00981389.2019.1653418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
While the frequency of children's behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011-2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.
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Affiliation(s)
- Sean Lynch
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Jesse Pines
- Department of Emergency Medicine, George Washington University , Washington , DC , USA
| | - Ryan Mutter
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Judith L Teich
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida-Jacksonville , Jacksonville , FL , USA
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9
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A Collaborative Behavioral Model for Psychiatric Visits in a Pediatric Emergency Department. Pediatr Emerg Care 2019; 35:461-467. [PMID: 28590994 DOI: 10.1097/pec.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Psychiatric pediatric emergency department (PED) visits are associated with extended length of stay (LOS) compared with nonpsychiatric visits. To address delays in definitive care, our PED incorporated a Collaborative Behavioral Model for patients with a psychiatric complaint. We evaluated LOS and 6-month readmission by comparing patients who received a psychiatric consultation through the model with a control group of nonpsychiatric patients. In addition, we assessed the utilization of laboratory tests and imaging and the impact of testing on final patient disposition. METHODS A matched-pair retrospective chart review of psychiatric PED visits was conducted for visits from January 1, 2009, to December 31, 2013. Patients who received a psychiatric diagnosis and consultation through the Collaborative Behavioral Model were included. Participants were matched with a control group of similar patients who did not receive a psychiatric diagnosis. RESULTS One hundred forty-seven patients met all the inclusion criteria. There was no statistical difference in median LOS for patients who received a psychiatric consultation versus nonpsychiatric visits (204 vs 200 minutes; P = 0.35). The 6-month PED readmission rate for psychiatric visits was significantly less than that in the control group (18% vs 32%; P = 0.003). Of the laboratory and imaging studies performed, 1 abnormal laboratory test (1%) and no imaging studies resulted in a change in patient management. CONCLUSIONS Collaborative models, with specialized psychiatric components, can better coordinate the care of mental health visits by providing focused interventions that promote efficient disposition. In addition, laboratory and imaging studies resulted in few changes in management or final disposition.
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Stewart SL, Poss JW, Thornley E, Hirdes JP. Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children's Mental Health. Health Serv Insights 2019; 12:1178632919827930. [PMID: 30828248 PMCID: PMC6390227 DOI: 10.1177/1178632919827930] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 12/27/2018] [Indexed: 11/25/2022] Open
Abstract
Children’s mental health care plays a vital role in many social, health care, and
education systems, but there is evidence that appropriate targeting strategies
are needed to allocate limited mental health care resources effectively. The aim
of this study was to develop and validate a methodology for identifying children
who require access to more intense facility-based or community resources.
Ontario data based on the interRAI Child and Youth Mental Health instruments
were analysed to identify predictors of service complexity in children’s mental
health. The Resource Intensity for Children and Youth (RIChY) algorithm was a
good predictor of service complexity in the derivation sample. The algorithm was
validated with additional data from 61 agencies. The RIChY algorithm provides a
psychometrically sound decision-support tool that may be used to inform the
choices related to allocation of children’s mental health resources and
prioritisation of clients needing community- and facility-based resources.
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Affiliation(s)
| | - Jeff W Poss
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
| | | | - John P Hirdes
- University of Waterloo, Faculty of Applied Health Sciences, Waterloo, ON, Canada
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Roman SB, Matthews-Wilson A, Dickinson P, Chenard D, Rogers SC. Current Pediatric Emergency Department Innovative Programs to Improve the Care of Psychiatric Patients. Child Adolesc Psychiatr Clin N Am 2018; 27:441-454. [PMID: 29933793 DOI: 10.1016/j.chc.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Emergency departments (EDs) across North America have become a safety net for patients seeking mental health (MH) services. The prevalence of families seeking treatment of children in MH crisis has become a national emergency. To address MH access and improve quality and efficient management of children with MH conditions, the authors describe ED projects targeting this vulnerable population. Five North American health care systems volunteered to feature projects that seek to reduce ED visits and/or improve the care of MH patients: Allina Health, Nationwide Children's Hospital, Children's Hospital of Eastern Ontario, Connecticut Children's Medical Center, and Rhode Island Hospital.
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Affiliation(s)
- Susan B Roman
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
| | - Allison Matthews-Wilson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Patricia Dickinson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Danielle Chenard
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Steven C Rogers
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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12
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Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth. CAN J EMERG MED 2017; 21:75-86. [DOI: 10.1017/cem.2017.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.
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Buntsma D, Lithgow A, O'Neill E, Palmer D, Morris P, Acworth J, Babl FE. Patterns of paediatric emergency presentations to a tertiary referral centre in the Northern Territory. Emerg Med Australas 2017; 29:678-685. [PMID: 29115723 DOI: 10.1111/1742-6723.12853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe epidemiological data concerning paediatric attendances at the ED of Royal Darwin Hospital (RDH). METHODS We conducted a retrospective cohort study of paediatric emergency presentations to the RDH ED during 2004 and 2013. Epidemiological data, including demographics, admission rates and diagnostic grouping, were analysed using descriptive and comparative statistical methods. We compared data with findings from a baseline epidemiological study by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) conducted in 2004. RESULTS A total of 12 745 and 15 378 paediatric presentations (age 0-18 years) to the RDH ED were analysed for the years 2004 and 2013 respectively. In 2004, the mean age of children presenting to RDH was 7.1 years, and 56.0% were female. Indigenous patients accounted for 31.2% of presentations at RDH and were significantly more likely to be admitted than non-Indigenous patients (31.6% vs 12.8%, OR 3.24, 95% CI 2.95-3.55). Children <5 years old accounted for the highest number of presentations (45.2%) and admissions (51.2%), and there was a high proportion of adolescent presentations (18.0%). Similar to the PREDICT study, viral infectious conditions (bronchiolitis, gastroenteritis, upper respiratory tract infections) were the most common cause for presentations. Key differences included a higher proportion of patients presenting with cellulitis and head injury at RDH and an increasing proportion of adolescent psychiatric presentations at RDH from 2004 to 2013. CONCLUSION This study provides important information regarding paediatric presentations to a major referral hospital in the Northern Territory. Overall, there was a disproportionate rate of presentation and admission among Indigenous children. Other key findings were higher proportions of cellulitis, head injury and adolescent presentations. These findings can assist in service planning and in directing future research specific to children in the Northern Territory.
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Affiliation(s)
- Davina Buntsma
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Anna Lithgow
- Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Evan O'Neill
- Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Didier Palmer
- Emergency Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Peter Morris
- Menzies School of Health Research Institute, Darwin, Northern Territory, Australia
| | - Jason Acworth
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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The Impact of Mental Health Services in a Pediatric Emergency Department: The Implications of Having Trained Psychiatric Professionals. Pediatr Emerg Care 2017; 33:311-314. [PMID: 27668915 DOI: 10.1097/pec.0000000000000836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. METHODS A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013. These subjects were diagnosed by the ED physician at the time of the visit using codes ranging from 290.0 to 319.0 based on the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. RESULTS The mean (SD) age of children in the postprogram period (14.3 ± 3.1) was younger than during the preprogram period (14.9 ± 3.1) (P < 0.001) with the greatest increase in the 11- to 15-year age group (42% vs 35%, respectively). Patients in the postprogram period were significantly more likely to be discharged to a psychiatric hospital than during the pre-program period (18% vs 9%, respectively). After the initiation of the program, ED length of stay decreased significantly from 14.7 to 12.1 hours (P < 0.001) and costs per visit decreased slightly from US $602 to US $588 (this difference was not statistically significant). CONCLUSIONS Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.
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Abstract
OBJECTIVES Mental health complaints are a frequent presentation to the pediatric emergency department (PED). It is unclear if having an on-site inpatient pediatric psychiatric unit impacts pediatric mental health care in the acute setting. The objective of this study was to compare PED mental health care between a pediatric tertiary care center with an associated inpatient child psychiatric unit (PAPED) and one that does not (NOPED) with the hypothesis that children have longer lengths of stay (LOS) at the PED without an inpatient unit. METHODS This was a retrospective, observational study of all mental health presentations aged 1 to 18 years to 2 tertiary care PEDs from March 2012 to June 2013 with a final mental health diagnosis International Classification of Diseases, Ninth Revision code. RESULTS A total of 1409 patient encounters comprised the study group. The PAPED had a significantly higher rate of admission 41.3% versus 18.8% (P < 0.0001). The LOS was significantly longer at the NOPED compared with the PAPED with a visit of 15.6 versus 6.3, respectively (P < 0.0001). When LOS was stratified for disposition, patients requiring admission from the NOPED had a significantly longer LOS of 33.4 compared with an emergency department LOS of 8.1 at the PAPED (P < 0.0001). CONCLUSIONS Mental health care in the PED seems to be affected by having an associated inpatient child psychiatric unit. Further research needs to address this growing problem and ways to utilize community resources to develop safe outpatient plans and divert admission if possible.
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Psychiatric emergencies of minors with and without migration background. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2016; 31:1-7. [PMID: 27966096 PMCID: PMC5348547 DOI: 10.1007/s40211-016-0213-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022]
Abstract
Background The conditions of children and adolescents with migration background receiving emergency psychiatric care in Europe are not well known. Migrants usually attend regular psychiatric care less frequently than the autochthonous population. We therefore speculated that, being undertreated, they would be overrepresented among psychiatric emergency care patients. Methods We retrospectively analyzed the records of 1093 minors aged 4‑18 years treated during a period of three years at the psychiatric emergency outpatient clinic of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. Results More minors with migration background than natives consulted our emergency clinic. Most frequent reasons for referral were suicide attempts by Turkish patients, acute stress disorder in Serbian/Croatian/Bosnian and in Austrian patients. Psychiatric diagnoses like eating and personality disorders were mostly diagnosed in natives. We found gender specific differences between the groups. Conclusions The reasons for these differences possibly relate to deficits of adequate mental health-care in Austria, to intercultural and intrafamiliar conflicts related to acculturation distress in the migrant population. Prospective longitudinal studies focusing on the utilization of mental health care by the migrant children and the impact of the migration background on their mental health are needed for improving adequate culture-sensitive mental-health care for this population.
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Pickner WJ, Puumala SE, Chaudhary KR, Burgess KM, Payne NR, Kharbanda AB. Emergency Department Utilization for Mental Health in American Indian Children. J Pediatr 2016; 174:226-231.e3. [PMID: 27131404 PMCID: PMC4925236 DOI: 10.1016/j.jpeds.2016.03.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/11/2016] [Accepted: 03/24/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine emergency department (ED) visits for mental health concerns by American Indian children in a multicenter cohort. To analyze demographic and clinical factors, the types of mental health concerns, and repeat mental health visits. STUDY DESIGN Cross-sectional study of children 5-18 years old who visited 1 of 6 EDs in the Upper Midwest from June 2011 to May 2012 and self-identified as white or American Indian. Mental health visits were identified by primary diagnosis and reasons for visit and were categorized into diagnostic groups. We explored racial differences in ED visits for mental health, diagnostic groups, and repeat mental health visits. Analysis involved χ(2) tests, Cochran-Mantel-Haenszel tests, and regression models including age, triage, timing, and insurance, and their interactions with race. RESULTS We identified 26 004 visits of which 1545 (5.4%) were for a mental health concern. The proportion of visits for mental health differed by race and age. American Indian children had lower odds of a mental health visit for 5-10 year olds (OR, 0.40; 95% CI, 0.26-0.60), but higher odds for 11-17 year olds (OR, 1.62; 95% CI, 1.34-1.95). In the older age group, American Indian children were seen primarily for depression and trauma- and stressor-related disorders, whereas white children were seen primarily for depression and disruptive, impulse control, and conduct disorders. Repeat visits were not different by race. CONCLUSIONS Differences were noted in mental health visits between American Indian and white children and were influenced by age. These findings warrant further investigation into care-seeking patterns and treatment for mental health in American Indian children.
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Affiliation(s)
| | - Susan E. Puumala
- Sanford Research, Sioux Falls, South Dakota,Sanford School of Medicine at the University of South Dakota, Sioux Falls, South Dakota
| | | | - Katherine M. Burgess
- Sanford Research, Sioux Falls, South Dakota,Colorado School of Public Health at the University of Colorado, Aurora, Colorado
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Mapelli E, Black T, Doan Q. Trends in Pediatric Emergency Department Utilization for Mental Health-Related Visits. J Pediatr 2015; 167:905-10. [PMID: 26256019 DOI: 10.1016/j.jpeds.2015.07.004] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 05/13/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe trends in utilization of pediatric emergency department (PED) resources by patients with mental health concerns over the past 11 [corrected] years at a tertiary care hospital. STUDY DESIGN We conducted a retrospective cohort study of tertiary PED visits from 2002 [corrected] to 2012. All visits with chief complaint or discharge diagnosis related to mental health were included. Variables analyzed included number and acuity of mental health-related visits, length of stay, waiting time, admission rate, and return visits, relative to non-mental health [corrected] PED visits. Descriptive statistics were used to summarize the results. RESULTS We observed a 47% increase in the number of mental health presentations compared with a 27.5% [corrected] increase in the number of total visits to the PED over the study period. Return visits represented a significant proportion of all mental health-related visits (32.2% [corrected] yearly). The proportion of mental health visits triaged to a high acuity level has decreased whereas the proportion of visits triaged to the mid-acuity level has increased. Length of stay for psychiatric patients was significantly longer than for visits to the PED in general. We also observed a 53.7% [corrected] increase in the number of mental health-related visits resulting in admission. CONCLUSION Mental health-related visits represent a significant and growing burden for the emergency department at a tertiary care PED. These results highlight the need to reassess the allocation of health resources to optimize acute management, risk assessment, and linkage to mental health services upon disposition from the PED.
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Affiliation(s)
- Elisa Mapelli
- Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, 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
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Sheridan DC, Spiro DM, Fu R, Johnson KP, Sheridan JS, Oue AA, Wang W, Van Nes R, Hansen ML. Mental Health Utilization in a Pediatric Emergency Department. Pediatr Emerg Care 2015; 31:555-9. [PMID: 25834957 PMCID: PMC4526317 DOI: 10.1097/pec.0000000000000343] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mental health complaints are frequent in the pediatric emergency department (PED). The objective of this study was to describe trends over time in PED utilization for mental health care at in a single pediatric tertiary care hospital. It is our hypothesis that the resources used by this patient population are high and that mental health-related visits have increased over the most recent decade. METHODS This was a retrospective study of all pediatric mental health presentations to the PED from January 2009 to July 2013 at a single pediatric hospital. All patients aged 1 to 19 years with an International Classification of Diseases, Ninth Revision code of 291, 292, 295 to 309, and 311 to 314 were included. Data collected included demographic data, medications received, restraint use, suicidality, length of stay (LOS), charges incurred, final disposition, and daily PED operation variables. Trends over time in presentation, charges, and LOS were analyzed using multiple mixed effects regression models after adjusting for potential patient and PED level confounding variables and clustering of multiple visits within patients. RESULTS A total of 732 PED visits from 2009 to 2013 were identified representing 646 unique patients. The average age was 13.8 years, and 53% were male. Approximately 25% of the patients expressed suicidal ideation, and 44% of those had attempted suicide before arrival. Behavioral or chemical restraints were used in 33% of patients during their PED visit. There were statistically significant increases in annual visits, LOS, and charges over this period (P < 0.05). Increased charges were significantly associated with longer LOS (P = 0.0062). Charges (P = 0.46) and LOS (P = 0.62) were not significantly different between suicidal and nonsuicidal patients. Approximately 21% of patients were admitted or transferred to another facility. CONCLUSIONS In this single-center study, we found evidence that the resources required to care for pediatric patients with mental health complaints have increased significantly over time both by increased number of annual visits and an increasing LOS. Further research is necessary to determine if our data are consistent with national trends to further our understanding of the problem and improve resource allocation.
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Affiliation(s)
- David C. Sheridan
- Department of Emergency Medicine, Oregon Health & Science University
| | - David M. Spiro
- Department of Emergency Medicine, Oregon Health & Science University
| | - Rongwei Fu
- Department of Emergency Medicine, Oregon Health & Science University
| | - Kyle P. Johnson
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University
| | - John S. Sheridan
- Department of Child & Adolescent Psychiatry, Oregon Health & Science University,Department of Care Management/Social Work, Oregon Health & Science University
| | - Alyssa A. Oue
- Department of Emergency Medicine, Oregon Health & Science University
| | - Wensi Wang
- Department of Emergency Medicine, Oregon Health & Science University
| | - Rachel Van Nes
- Department of Emergency Medicine, Oregon Health & Science University
| | - Matthew L. Hansen
- Department of Emergency Medicine, Oregon Health & Science University
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Abstract
OBJECTIVE Recent research suggests that increasing numbers of caregivers are bringing their children to the emergency department (ED) for mental health services and that a large proportion of these children have Medicaid as their insurance. The objective of this study was to examine the characteristics of children with Medicaid who present with psychiatric conditions in Florida hospital EDs. METHODS A retrospective research design was used, and the insurance claims of children who went to the ED for mental health care were analyzed. A logistic regression model was constructed to determine whether age, race, ethnicity, sex, and residence in an area with mental health professional shortage increased the odds of a psychiatric ED visit for children with Medicaid. RESULTS All 5 predictor variables were significantly associated with the likelihood of an ED visit for mental health reasons by children with Medicaid. CONCLUSIONS The ED is an entry point into the child mental health system of care for children with Medicaid.
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CARES: improving the care and disposition of psychiatric patients in the pediatric emergency department. Pediatr Emerg Care 2015; 31:173-7. [PMID: 25706924 DOI: 10.1097/pec.0000000000000378] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Pediatric psychiatric emergencies are a nationwide crisis and have contributed to an increase in behavioral health emergency department (ED) visits. A collaborative response to this crisis was the creation of the Child & Adolescent Rapid Emergency Stabilization (CARES) program. The objective of this study is to determine how the CARES unit influenced length of stay (LOS) and costs for psychiatric patients in the pediatric ED. METHODS A retrospective review of ED patients was conducted. Children presenting 1 year before CARES, October 13, 2006, to October 13, 2007 (pre-CARES), were compared with 1 year after, October 15, 2007, to October 15, 2008 (post-CARES). The study population includes all patients presenting to the ED with psychiatric illnesses. The primary outcome is mean LOS in hours. Supplemental analyses of total charges, payments, and costs were performed. RESULTS There were 1719 visits before and 1867 visits after CARES, with 1190 and 1273 unique patient visits, respectively. Children in both groups had similar age, gender, and ethnicity. Pre-CARES had a mean LOS of 19.7 hours (SD, 32.6), whereas post-CARES had 10.8 hours (SD, 19.9) (P < 0.0001). Evaluating only unique visits, the difference remained highly significant. Post-CARES, compared with pre-CARES, the average charge per patient decreased by $905 (P < 0.0001), average payment decreased by $111 (P < 0.06), and average total cost decreased by $569 or 38.7% (P < 0.0001). The total cost savings the year after CARES opened was $1,019,168.55.
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Tossone K, Jefferis ES, Grey SF, Bilge-Johnson S, Bhatta MP, Seifert P. Poly-traumatization and harmful behaviors in a sample of emergency department Psychiatric Intake Response Center youth. CHILD ABUSE & NEGLECT 2015; 40:142-151. [PMID: 25510557 DOI: 10.1016/j.chiabu.2014.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
The purpose of this study is to examine risk factors for poly-traumatization, and the impact of poly-traumatization on harmful behaviors (suicidal, self-harm, and violent), among a group of pediatric patients presenting at an emergency department's psychiatric intake response center. We employed a retrospective medical chart review in a children's hospital for a 2-year span (N=260). The study employed 2 statistical analyses. The first analysis used multinomial logistic regression to model the odds of harmful behaviors comparing increasing numbers of co-occurring traumatization types. The second analysis employed latent class modeling techniques in three ways to (a) define different poly-traumatization populations, (b) examine the relationship between predictors and class assignment, and (c) examine the relationship between class assignment and harmful behavioral outcomes. About 62% of the sample presented with at least 1 traumatization type and about 50% one harmful behavior type. Compared to those with 1, 2, or 3 traumatization types, patients with 4 or more traumatization types have higher odds of harmful behaviors. The latent class analysis revealed 2 populations: High serious victimization and minimal traumatization. History of family mental health issues was the only significant predictor of class membership. Class membership was associated with all of the harmful behavioral outcome categories. These findings support consideration of poly-traumatization as a risk factor for the high occurrence of harmful behaviors in this sample of pediatric psychiatric patients and that history of family mental health issues may contribute to the high co-occurrence of poly-traumatization.
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Simon AE, Schoendorf KC. Emergency department visits for mental health conditions among US children, 2001-2011. Clin Pediatr (Phila) 2014; 53:1359-66. [PMID: 25006117 PMCID: PMC4642281 DOI: 10.1177/0009922814541806] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined mental health-related visits to emergency departments (EDs) among children from 2001 to 2011. We used the National Hospital Ambulatory Medical Care Survey-Emergency Department, 2001-2011 to identify visits of children 6 to 20 years old with a reason-for-visit code or ICD-9-CM diagnosis code reflecting mental health issues. National percentages of total visits, visit counts, and population rates were calculated, overall and by race, age, and sex. Emergency department visits for mental health issues increased from 4.4% of all visits in 2001 to 7.2% in 2011. Counts increased 55,000 visits per year and rates increased from 13.6 visits/1000 population in 2001 to 25.3 visits/1000 in 2011 (P < .01 for all trends). Black children (all ages) had higher visit rates than white children and 13- to 20-year-olds had higher visit rates than children 6 to 12 years old (P < .01 for all comparisons). Differences between groups did not decline over time.
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Affiliation(s)
- Alan E. Simon
- Infant, Child, and Women’s Health Statistics Branch, Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Kenneth C. Schoendorf
- Infant, Child, and Women’s Health Statistics Branch, Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD,US Public Health Service, Rockville, MD
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Tossone K, Jefferis E, Bhatta MP, Bilge-Johnson S, Seifert P. Risk factors for rehospitalization and inpatient care among pediatric psychiatric intake response center patients. Child Adolesc Psychiatry Ment Health 2014; 8:27. [PMID: 25392713 PMCID: PMC4228274 DOI: 10.1186/1753-2000-8-27] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/29/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The study sought to explore the characteristics, risk factors for inpatient recommendation, and risk factors for revisits to a pediatric psychiatric intake response center (PIRC). There are three research questions: 1. What is the general profile of pediatric patients who present at the PIRC? 2. What are the risk factors for patients who repeatedly visit the PIRC? 3. What are the risk factors for PIRC patients who are recommended to inpatient care? METHODS The study utilized a retrospective medical chart review of a random sample (n = 260). A PIRC profile was created using frequency and prevalence calculations, in addition to a survival analysis of patients who return to the PIRC in order to determine how long it takes for PIRC patients to return to the PIRC. Factors that contribute to increased odds of returning to PIRC and being recommended for inpatient treatment were calculated using two logistic regression analyses. RESULTS The average pediatric PIRC patient is about 13 years old, Caucasian, with Medicaid and comes from a divorced or single parent household. About 43% of patients presented at PIRC for suicidal thoughts, ideation, intentions or actions. At least 63% of patients have a history of victimization. The average time to return to PIRC is about 90 days. Patients with a history of victimization, suicidal behavior, learning problems, problems with peers, and a history of violence were at an increased odds of returning to the PIRC. Those patients who were previously admitted to inpatient care and had a family history of mental health issues were at increased odds of being recommended to inpatient treatment. CONCLUSIONS This sample presents with a multitude of issues that contribute to increased odds of revisits to PIRC and inpatient recommendation. These issues seem to come from multiple levels of influence. Future research should expand to similar treatment facilities and use a prospective design to confirm risk factors. Treatment for pediatric psychiatric patients may focus on multiple factors that influence patients' mental health.
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Affiliation(s)
- Krystel Tossone
- Kent State University, Lowry Hall, 750 Hilltop Drive, PO Box 5190, Kent, OH 44242 USA
| | - Eric Jefferis
- Kent State University, Lowry Hall, 750 Hilltop Drive, PO Box 5190, Kent, OH 44242 USA
| | - Madhav P Bhatta
- Kent State University, 319 Lowry Hall, PO Box 5190, Kent, OH 44242 USA
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Taastrøm A, Klahn J, Staal N, Thomsen PH, Johansen A. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County. Nord J Psychiatry 2014; 68:385-90. [PMID: 24161251 DOI: 10.3109/08039488.2013.846410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Knowledge on psychiatric emergencies in children and adolescents is limited. The Psychiatric Emergency Departments (PED) in Copenhagen enable the acute examination of children and adolescents 24 h a day, 7 days a week. However, very little is known about who presents to the PED, and the reason for their visit. AIM To describe the prevalence and characteristics of presentations in PED and treatment provided. METHODS A retrospective population based study comprising data of more than 4000 visitors presenting to PED from 2001-2010. In 2003 and 2006, two randomly chosen years, a more thorough analysis was performed, based on the individual emergency charts. Inter-rater reliability was high. RESULTS Visits increased nearly threefold during the period. Symptom score for 2003 and 2006 revealed that more than one third of the visitors had suicidal ideation. Depressive and anxiety symptoms together with suicidal ideation rose significantly (P < 0.001). Psychoses and suicidal attempts remained unchanged. In one third of the visits, the discharge diagnosis was anxiety and stress-related disorders, followed by personality, behavioural and emotional disorders. Between 15% and 20% of the visits resulted in admission and more than 50% in referral for outpatient follow-up. CONCLUSIONS The number of presenting psychiatric emergencies has increased over the last 10 years. Comparing symptoms from 2003 and 2006 showed a significant rise in their severity. This study highlights the need for 24-h access for acute evaluation by physicians skilled in child and adolescent psychiatry, and raises concern that the severity could increase.
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Affiliation(s)
- Annette Taastrøm
- Centre for Child and Adolescents Psychiatry , Glostrup, Copenhagen , Denmark
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Clinical Utility of Screening Laboratory Tests in Pediatric Psychiatric Patients Presenting to the Emergency Department for Medical Clearance. Ann Emerg Med 2014; 63:666-75.e3. [DOI: 10.1016/j.annemergmed.2013.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 09/08/2013] [Accepted: 10/08/2013] [Indexed: 11/23/2022]
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Newton AS, Rathee S, Grewal S, Dow N, Rosychuk RJ. Children's Mental Health Visits to the Emergency Department: Factors Affecting Wait Times and Length of Stay. Emerg Med Int 2014; 2014:897904. [PMID: 24563785 PMCID: PMC3915921 DOI: 10.1155/2014/897904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 12/02/2013] [Accepted: 12/10/2013] [Indexed: 11/20/2022] Open
Abstract
Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS). Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs). Results. Sex (male: HR = 1.48, 95% CI = 1.20-1.84), ED type (pediatric ED: HR = 5.91, 95% CI = 4.16-8.39), and triage level (Canadian Triage and Acuity Scale (CTAS) 2: HR = 3.62, 95% CI = 2.24-5.85) were statistically significant predictors of wait time. ED type (pediatric ED: HR = 1.71, 95% CI = 1.18-2.46), triage level (CTAS 5: HR = 2.00, 95% CI = 1.15-3.48), number of consultations (HR = 0.46, 95% CI = 0.31-0.69), and number of laboratory investigations (HR = 0.75, 95% CI = 0.66-0.85) predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.
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Affiliation(s)
- Amanda S. Newton
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Room 3-526, Edmonton, AB, Canada T6G 1C9
| | - Sachin Rathee
- Faculty of Medicine & Dentistry, University of Alberta, WC Mackenzie Health Sciences Centre, Edmonton, AB, Canada T6G 2R7
| | - Simran Grewal
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Room 3-582B, Edmonton, AB, Canada T6G 1C9
| | - Nadia Dow
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Room 3-582, Edmonton, AB, Canada T6G 1C9
| | - Rhonda J. Rosychuk
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), 11405-87 Avenue, Room 3-524, Edmonton, AB, Canada T6G 1C9
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Abstract
OBJECTIVES Over the years, increasing numbers of children and adolescents have sought help for acute psychiatric problems. The responses to this treatment-seeking behavior are heterogeneous in different settings and nations. This review aimed to provide an answer to the questions "which care should be offered to children and adolescents presenting with a psychiatric emergency or crisis and how should it be organized." METHODS We committed a literature review to find out if any recommendations can be made regarding the organization of emergency care for children and adolescents with acute mental health problems. RESULTS The lack of a clear definition of emergencies or urgencies hampered this review; we note the differences between adult and child or adolescent psychiatry. The theoretical models of care found in the literature are built up from several process and structural components, which we describe in greater detail. Furthermore, we review the main service delivery models that exist for children and adolescents. CONCLUSIONS Currently, emergency psychiatric care for children and adolescents is practiced within a wide range of care models. There is no consensus on recommended care or recommended setting for this population. More research is needed to make exact recommendations on the standardization of psychiatric care for young people in emergency settings.
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Dedicated pediatric behavioral health unit: serving the unique and individual needs of children in behavioral health crisis. Pediatr Emerg Care 2013; 29:200-2. [PMID: 23364387 DOI: 10.1097/pec.0b013e318280d54c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric mental health emergencies are an increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. The emergency services for behavioral health unit at Akron Children's Hospital is an innovative model for delivering care to pediatric patients with mental health emergencies. A multidisciplinary team using the expertise of emergency services, psychiatry, social work, parent advisory counsel, security services, and engineering/architecture developed the emergency services for behavioral health unit blueprint, process, and staffing model.
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Boyer L, Henry JM, Samuelian JC, Belzeaux R, Auquier P, Lancon C, Da Fonseca D. Mental Disorders among Children and Adolescents Admitted to a French Psychiatric Emergency Service. Emerg Med Int 2013; 2013:651530. [PMID: 23431454 PMCID: PMC3568896 DOI: 10.1155/2013/651530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 12/24/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to describe the characteristics of children and adolescents admitted to the psychiatric emergency department (ED) of a French public teaching hospital over a six-year study period (2001-2006). Data for all episodes of care in the psychiatric ED from January 1, 2001, to December 31, 2006, delivered to adolescents aged less than 18 years were retrospectively analyzed. During the six-year study period, 335 episodes of care in the psychiatric ED were experienced by 264 different adolescents. They accounted for 2.0% of the 16,754 care episodes of the ED; 164 patients (62.1) were female and the average age was 16.5 (SD = 1.6). The neurotic, stress-related, and somatoform disorders were the most frequent (25.4%) and concerned mainly anxiety disorders (15.2%). The frequency of the absence of psychiatric diagnosis (22.7%) was high. A total of 48 children and adolescents (18.2%) benefited from more than one episode of care. Several factors were associated to a higher number of visits to the ED: substance use, schizophrenia, disorders of adult personality and behaviour, disorders occurring in childhood and adolescence, and dual diagnosis. In conclusion, mental health disorders in children and adolescents are a serious problem associated with several potentially modifiable factors.
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Affiliation(s)
- Laurent Boyer
- EA 3279, Self-Perceived Health Assessment Research Unit, Faculté de Médicine, Université Aix-Marseille, 13005 Marseille, France
| | - Jean-Marc Henry
- Department of Psychiatry, AP-HM Hôpital de la conception, 13855 Marseille, France
| | | | - Raoul Belzeaux
- Department of Psychiatry, AP-HM Hôpital Sainte-Marguerite, 13274 Marseille, France
| | - Pascal Auquier
- EA 3279, Self-Perceived Health Assessment Research Unit, Faculté de Médicine, Université Aix-Marseille, 13005 Marseille, France
| | - Christophe Lancon
- EA 3279, Self-Perceived Health Assessment Research Unit, Faculté de Médicine, Université Aix-Marseille, 13005 Marseille, France
- Department of Psychiatry, AP-HM Hôpital Sainte-Marguerite, 13274 Marseille, France
| | - David Da Fonseca
- Department of Pedosychiatry, AP-HM Hôpital Sainte-Marguerite & Salvator, 13274 Marseille, France
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Temporal trends in pediatric mental health visits: using longitudinal data to inform emergency department health care planning. Pediatr Emerg Care 2012; 28:620-5. [PMID: 22743753 DOI: 10.1097/pec.0b013e31825cf93b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Understanding the temporality of mental health presentations to the emergency department (ED) during the 24-hour cycle, day of the week, and month of the year may facilitate strategic planning of ED-based mental health services. METHODS Data on 30,656 ED presentations for mental illness, substance use, or intentional self-harm by 20,956 patients (≤ 17 years) were examined. We studied patient demography, discharge diagnosis, and time and date of presentation. RESULTS Most pediatric mental health ED visits (66.0%) occurred after the average work and school day (after 5 PM). Presentations related to substance use and intentional self-harm steadily increased in the evening. Emergency department visits related to substance use peaked on Friday through Sunday (4723/7475; 63.2%), whereas visits for mood disorders (4127/5093; 81.0%), neurotic/stress-related disorders (5960/7989; 74.6%), and behavioral/emotional disorders (237/304; 78%) were highest during the work/school week (Monday to Friday). Visits for intentional self-harm peaked following the weekend (Monday: 771/4676; 16.5%). Summer months had fewer visits (6862/30,656; 22.4%), whereas March to May (range: 2752-2912 visits) and October to November (range: 2701-2751 visits) showed more steady peaks in volume. Most presentations by diagnostic group decreased in volume during the winter months (December to February) to increase again in the spring (March to May). CONCLUSIONS Peak times for pediatric mental health presentations to the ED are evenings throughout the week, suggesting that mental health services for children, adolescents, and their families should be available after work and school hours, 7 days a week.
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Carlisle CE, Mamdani M, Schachar R, To T. Aftercare, emergency department visits, and readmission in adolescents. J Am Acad Child Adolesc Psychiatry 2012; 51:283-293.e4. [PMID: 22365464 DOI: 10.1016/j.jaac.2011.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 11/17/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE U.S. and Canadian data demonstrate decreasing inpatient days, increasing nonurgent emergency department (ED) visits, and short supply of child psychiatrists. Our study aims to determine whether aftercare reduces ED visits and/or readmission in adolescents with first psychiatric hospitalization. METHOD We conducted a population-based cohort analysis using linked health administrative databases with accrual from April 1, 2002, to March 1, 2004. The study cohort included all 15- to 19-year-old adolescents with first psychiatric admission. Adolescents with and without aftercare in the month post-discharge were matched on their propensity to receive aftercare. Our primary outcome was time to first psychiatric ED visit or readmission. Secondary outcomes were time to first psychiatric ED visit and readmission, separately. RESULTS We identified 4,472 adolescents with first-time psychiatric admission. Of these, 57% had aftercare in the month post-discharge. Propensity-score-based matching, which accounted for each individual's propensity for aftercare, produced a cohort of 3,004 adolescents. In matched analyses, relative to those with no aftercare in the month post-discharge, those with aftercare had increased likelihood of combined outcome (hazard ratio [HR] = 1.22, 95% confidence interval [CI] = 1.05-1.42), and readmission (HR = 1.38, 95% CI = 1.14-1.66), but not ED visits (HR = 1.14, 95% CI = 0.95-1.37). CONCLUSIONS Our results are provocative: we found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit. Over and above confounding by severity and Canadian/U.S. systems differences, our results may indicate a relative lack of psychiatric services for youth. Our results point to the need for improved data capture of pediatric mental health service use.
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Case SD, Case BG, Olfson M, Linakis JG, Laska EM. Length of stay of pediatric mental health emergency department visits in the United States. J Am Acad Child Adolesc Psychiatry 2011; 50:1110-9. [PMID: 22023999 PMCID: PMC3241993 DOI: 10.1016/j.jaac.2011.08.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 08/23/2011] [Accepted: 08/31/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare pediatric mental health emergency department visits to other pediatric emergency department visits, focusing on length of stay. METHOD We analyzed data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of US emergency department visits from 2001 to 2008, for patients aged ≤18 years (n = 73,015). Visits with a principal diagnosis of a mental disorder (n = 1,476) were compared to visits (n = 71,539) with regard to patient and hospital characteristics, treatment, and length of stay. Predictors of prolonged mental health visits were identified. RESULTS Mental health visits were more likely than other visits to arrive by ambulance (21.8% versus 6.3%, p < .001), to be triaged to rapid evaluation (27.9% versus 14.9%, p < .001), and to be admitted (16.4% versus 7.6%, p < .001) or transferred (15.7% versus 1.5%, p < .001). The median length of stay for mental health visits (169 minutes) significantly exceeded that of other visits (108 minutes). The odds of extended stay beyond 4 hours for mental health visits was almost twice that for other visits (adjusted odds ratio 1.9, 95% CI = 1.5-2.4) and was not explained by observed differences in evaluation, treatment, or disposition. Among mental health visits, advancing calendar year of study, intentional self-injury, age 6-13 years, Northeastern, Southern, and metropolitan hospital location, use of laboratory studies, and patient transfer all predicted extended stays. CONCLUSIONS Compared with other pediatric emergency visits, mental health visits are longer, are more frequently triaged to urgent evaluation, and more likely to result in patient admission or transfer, thereby placing distinctive burdens on US emergency departments.
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Affiliation(s)
- Sarah D Case
- Warren Alpert Medical School of Brown University, USA
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Exploring differences in the clinical management of pediatric mental health in the emergency department. Pediatr Emerg Care 2011; 27:275-83. [PMID: 21490541 DOI: 10.1097/pec.0b013e31821314ca] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : We examine psychiatric and pediatric clinical management of pediatric mental health in the emergency department (ED). METHODS : We conducted a retrospective review of health care delivery with a random sample of all pediatric mental health presentations (≤18 years) to 2 urban tertiary care EDs between 2004 and 2006 (N = 580). RESULTS : The EDs differed significantly in services offered. General emergency medicine-trained physicians provided care at 1 site (54.6%) with a number of visits also managed by a psychiatric crisis team (45.4%). Care at the other ED was delivered by pediatric emergency medicine-trained physicians (99.4%) with no regular on-site psychiatric services. The most common assessment provided across sites and all presentations was for suicidality (66.2%). After controlling for potential confounders, receipt of clinical assessment for homicidality, mood, or reality testing differed between EDs (P = 0.044, P = 0.006, and P = 0.002) with more assessments documented at the psychiatric-resourced ED. Brief counseling was lacking for visits (absence of documentation: 56.1% pediatric-resourced, 23.1% psychiatric-resourced ED); there was no evidence of site differences in provision. More psychiatric consultation was provided at the psychiatric-resourced ED (34.1% vs 27.4%, P = 0.030). Discharge recommendations were lacking in both EDs but were more incomplete for pediatric-resourced ED visits (P = 0.035). CONCLUSIONS : Consistent and comprehensive clinical management of pediatric mental health presentations was lacking in EDs that had pediatric and psychiatric resources. Prospective evaluations are needed to determine the effect of current clinical ED practices on patient and family outcomes, including symptom reduction and stress, as well as subsequent system use.
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A retrospective look at length of stay for pediatric psychiatric patients in an urban emergency department. Pediatr Emerg Care 2011; 27:170-3. [PMID: 21346682 DOI: 10.1097/pec.0b013e31820d644b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the study was to compare the length of stay (LOS) of patients with psychiatric diagnoses in a pediatric emergency department (ED) to that of patients with nonpsychiatric diagnoses. METHODS This is a retrospective review of all patients younger than 19 years with psychiatric conditions, who presented to an urban teaching hospital ED with psychiatric symptoms, from January 2004 to December 2007. A control group of patients with nonpsychiatric diagnoses was selected over a random 4-day period. Emergency department LOS (in minutes) of nonpsychiatric versus psychiatric patients was compared. Length of stay was determined from the time of triage to disposition (discharge or admission). Patients with psychiatric diagnoses were further classified into 1 of 2 categories: major psychiatric diagnoses (bipolar disorder, psychoses, major depression, suicidal attempt or ideation, homicidal ideation, and hallucination) and minor psychiatric diagnoses (attention deficit/hyperactivity disorder, adjustment disorder, anxiety or panic attack, and behavioral issues). RESULTS A total of 1468 patients with psychiatric diagnoses visited the ED. Three hundred eighty-two patients had major psychiatric diagnoses, and 1086 patients had minor psychiatric diagnoses. The control group (patients with nonpsychiatric diagnosis) consisted of 345 patients. Mean LOS of nonpsychiatric patients was 160 minutes (95% confidence interval [CI], 142-177 minutes); LOS for minor psychiatric patients was 737 minutes (95% CI, 670-803 minutes) and 1127 minutes for major psychiatric patients (95% CI, 972-1283 minutes). On the other hand, median LOS of nonpsychiatric patients was 129 minutes; minor psychiatric patients, 328 minutes; and major psychiatric patients, 437.5 minutes. Kruskal-Wallis test showed a significant difference between each group with P = 0.0001. CONCLUSIONS The LOS was significantly higher in patients with psychiatric diagnoses. The mean and median for LOS both rose steadily from nonpsychiatric to major psychiatric diagnoses.
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Abstract
The purpose of this study was to explore the structure, process, and outcomes of emergency department (ED) psychiatric services that are available to children who present with behavioral health problems. The author designed and employed a 33-item survey for data collection. All nonfederal EDs in one southeastern state (N=68) were solicited to participate. Descriptive analyses including ANOVAs, t tests, and chi-squares summarized sample characteristics and group differences by ED pediatric psychiatric service (EDPPS) arrangement. Thirty-four hospitals participated, sharing similar organizational characteristics with nonresponders except that participating hospitals were significantly more likely to have inpatient psychiatric services. The survey successfully captured data confirming that EDs use a range of strategies to manage children with behavioral health problems, raising concerns about the suitability of such service variation. These results highlight the need for further research that examines the association of EDPPS structure and process with patient and organizational outcomes to inform quality improvements in pediatric behavioral healthcare.
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Vibha P, Saddichha S. The burden of behavioral emergencies: need for specialist emergency services. Intern Emerg Med 2010; 5:513-9. [PMID: 20454871 DOI: 10.1007/s11739-010-0397-2] [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] [Received: 02/09/2010] [Accepted: 04/07/2010] [Indexed: 10/19/2022]
Abstract
Behavioral emergencies constitute an important component of medical emergencies. Psychiatric emergency services, which handle the bulk of behavioral emergencies, are inadequate to meet the burden. Strategies to deal with them are also hampered by the lack of adequate research and availability of data. Since behavioral emergencies may present differently in different groups, requiring differing management, consensus guidelines need to be arrived at for tackling behavioral emergencies. In addition, training professionals for psychiatric emergency services should form a part and parcel of emergency management services.
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Affiliation(s)
- Pandey Vibha
- Division of Clinical Research, Emergency Management and Research Institute, Devar Yemzal, Medchal Road, Hyderabad 500014, India
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Dion J, Kennedy A, Cloutier P, Gray C. Evaluating Crisis Intervention Services for Youth within an Emergency Department: A View from Within. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/13575271003789356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, Keaschuk RA, Jacobs P, Cappelli M, Klassen TP. Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care. Acad Emerg Med 2010; 17:177-86. [PMID: 20370747 DOI: 10.1111/j.1553-2712.2009.00633.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to investigate predictors of emergency department (ED) return visits for pediatric mental health care. The authors hypothesized that through the identification of clinical and health system variables that predict return ED visits, which children and adolescents would benefit from targeted interventions for persistent mental health needs could be determined. METHODS Data on 16,154 presentations by 12,589 pediatric patients (<or=17 years old) were examined from 2002 to 2006, using the Ambulatory Care Classification System (ACCS), a provincewide database for Alberta, Canada. Multivariable logistic regressions identified predictors, while survival analyses estimated time to ED return. RESULTS In the multivariable analysis, there were four patient factors significantly associated with ED return. Male sex (odds ratio [OR] = 0.78; 99% confidence interval [CI] = 0.69 to 0.89) was associated with a lower rate of return, as was child age. The likelihood of ED return increased with age. Children <or=5 years (OR = 0.26; 99% CI = 0.14 to 0.46) and between ages 6 and 12 (OR = 0.64; 99% CI = 0.51 to 0.79) were less likely to return, compared to 13- to 17-year-olds. Patients with families receiving full assistance for covering government health care premiums were more likely to return compared to those with no assistance (OR = 1.59; 99% CI = 1.33 to 1.91). Patients were more likely to return if their initial presentation was for a mood disorder (OR = 1.72; 99% CI = 1.46 to 2.01) or psychotic-related illness (OR = 2.53; 99% CI = 1.80 to 3.56). There were two modest health care system predictors in the model. The likelihood of return decreased for patients triaged as nonurgent (OR = 0.62; 99% CI = 0.45 to 0.87) versus those triaged as urgent (level 3 acuity) and increased for patients with visits to general (vs. pediatric) EDs (OR = 1.25; 99% CI = 1.03 to 1.52). ED region (urban vs. rural) did not predict return. Within 72 hours of discharge, 6.1 and 8.7% of patients diagnosed with a mood disorder and psychotic-related illness, respectively, returned to the ED. Throughout the study period, 28.5 and 36.6% of these diagnostic populations, respectively, returned to the ED. CONCLUSIONS Among children and adolescents who accessed the ED for mental health concerns, being female, older in age, in receipt of social assistance, and having an initial visit for a mood disorder or psychotic-related illness were associated with return for further care. How patient presentations were triaged and whether visits were made to a pediatric or general ED also affected the likelihood of return.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Pediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters. J Behav Health Serv Res 2009; 38:68-79. [DOI: 10.1007/s11414-009-9192-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 08/22/2009] [Indexed: 10/20/2022]
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Establishing best practice in pediatric emergency mental health: a prospective study examining clinical characteristics. Pediatr Emerg Care 2009; 25:380-6. [PMID: 19458565 DOI: 10.1097/pec.0b013e3181a79223] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this prospective study were to determine the demographic and clinical characteristics of children and youth presenting to the emergency department (ED) for mental health concerns through the use of a valid standardized assessment protocol. METHODS Children and adolescents, 8 to 17 years, who presented to an ED-based crisis intervention program during fiscal years 2005 to 2006, completed self-report measures of depression, anxiety, and behavior. Clinicians completed the childhood acuity of psychiatric illness based on their assessment. RESULTS The clinician ratings indicated that 93.1% of the sample had at least 1 risk behavior or clinical symptom in the moderate/severe range. Admittance rate for the sample was 17.9% (low-risk admissions, 5.8%; high-risk deflections, 9%). Significant differences were found in presentations by sex and age as follows: (1) female youths (12-17 years) were more likely than male youth to report clinically significant depressive symptoms and to present with suicidal ideation/gesture and self-injury. (2) Male youths (12-17 years) were more likely to present with aggression to people/objects than female youth. (3) Male children younger than 12 years were more likely to present with high activity level than female children. Self-report measures (depression, anxiety, and behavior) corelated with corresponding clinician ratings. CONCLUSIONS This research, through the use of a multi-informant standardized assessment protocol, presents a comprehensive study of children and youth presenting to the ED with mental health issues. Identifying the clinical characteristics of this population is an important first step toward establishing best practice within an ED.
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Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments. Pediatr Emerg Care 2009; 25:217-20. [PMID: 19382317 DOI: 10.1097/pec.0b013e31819e3523] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the patterns of referral and use of resources for patients with psychiatric-related visits presenting to pediatric emergency departments (EDs) in a pediatric research network. METHODS We conducted a retrospective chart review of a random sample of patients (approximately 10 charts per month per site) who presented with psychiatric-related visits in 2002 to 4 pediatric EDs in the Pediatric Emergency Care Applied Research Network. Emergency department resource use variables evaluated included the use of consultation services, restraints, and laboratory tests as well as ED length of stay. RESULTS We reviewed 462 patient visits with a psychiatric-related ED diagnosis. Mean (SD) age was 12.8 (3.7) years, 52% were male, and 49% were African American. The most common chief complaints were suicidality (47%), aggression/agitation (42%), and anxiety/depression (27%), alone or in combination. Ninety percent of patients (range across sites, 83%-94%) had a mental health consult in the ED, 5% were restrained (range, 3%-9%), and 35% had a laboratory test performed (range, 15%-63%). Mean (SD) ED length of stay was 5.1 (5.4) hours, and 52% were admitted (93% to a psychiatric bed, including transfers to separate psychiatric facilities). CONCLUSIONS Children with psychiatric-related visits seem to require substantial ED resources. Interventions are needed to reduce the burden on the ED by increasing the linkage to mental health services, particularly for suicidal youths.
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Oreskovic NM, Strother CG, Zibners LM. An unusual case of a central nervous system tumor presenting as a chief complaint of depression. Pediatr Emerg Care 2007; 23:486-8. [PMID: 17666934 DOI: 10.1097/01.pec.0000280522.22946.a7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients presenting to the emergency department with a psychiatric chief complaint often undergo a medical clearance examination. There is much debate in the literature as to the value of routine laboratory and other diagnostic studies in the initial evaluation of these patients. We report on a patient presenting to the pediatric emergency department with a chief complaint of depression who ultimately was found to have diabetes insipidus and a primary intracranial germ cell tumor. Although a rare outcome to a relatively common scenario in the emergency department, this case underscores the value of a detailed history, careful physical examination, and consideration of laboratory and other diagnostic studies in patients presenting to the emergency department for psychiatric evaluation.
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Affiliation(s)
- Nicolas M Oreskovic
- Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA
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Habis A, Tall L, Smith J, Guenther E. Pediatric emergency medicine physicians' current practices and beliefs regarding mental health screening. Pediatr Emerg Care 2007; 23:387-93. [PMID: 17572523 DOI: 10.1097/01.pec.0000278401.37697.79] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population. OBJECTIVE To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening. METHODS A 23-question survey on screening practices for pediatric mental illness (PMI) was sent to PEM physician participants identified through the American Academy of Pediatrics Section on Emergency Medicine mailing list. RESULTS Of the 576 physicians meeting our inclusion criteria, 384 (67%) surveys were returned. Eighty-six percent of respondents indicated screening for PMI in 10% or less of their eligible patients. Overall, 43% of respondents indicated screening only if the chief complaint was psychiatric in nature. The remaining 217 physicians most commonly screened for depression (83%), suicidality (76%), and substance abuse (67%). Only 9% of physicians stated that they used evidence-based medicine in determining their screening practices. Women physicians (odds ratio, 1.94; 95% confident interval, 1.08-3.47) and those using evidence-based medicine (odds ratio, 3.88; 95% confidence interval, 1.92-7.85) were more likely to conduct screening. Significant limitations to screening identified by respondents include the following: time limitations (93%), absence of a validated screening tool (62%), limited resources (46%), and lack of training (44%). Eighty-eight percent of physicians believe that a validated and standardized screening tool would improve their ability to identify PMI. CONCLUSIONS Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.
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Affiliation(s)
- Arie Habis
- Division of Pediatric Emergency Medicine, Children's Memorial at Central Dupage Hospital, Northwestern University Feinberg School of Medicine, Winfield, IL 60190, USA.
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L'accueil d'urgence en psychiatrie de l'enfant et de l'adolescent: évolution sur 20 ans dans un site hospitalo-universitaire. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.neurenf.2006.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stewart C, Spicer M, Babl FE. Caring for adolescents with mental health problems: challenges in the emergency department. J Paediatr Child Health 2006; 42:726-30. [PMID: 17044902 DOI: 10.1111/j.1440-1754.2006.00959.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore management issues in adolescents with mental health problems who presented to a children's hospital emergency department (ED). METHODS Retrospective chart review of all mental health presentations of adolescents (12-18 years) to a tertiary children's hospital ED, over a 1-year period (2003-2004). Patients were identified based on a search of the electronic ED log. Medical and mental health records were manually abstracted. RESULTS There were 203 presentations during the study period. Eighteen per cent of patients presented more than once. Mean age was 14.7 years, 73% were female and 67% presented after 6 pm. Fifty-seven per cent presented with non-accidental overdose, self-harm or suicide risk. There were 110 security incidents in 26% of presentations during the ED stay. A total of 47% were admitted, 27% to the medical inpatient service and 20% to a psychiatric inpatient facility. CONCLUSION Adolescent mental health presentations to the ED require a high number of ED, mental health and inpatient service resources. Security incidents occur frequently. We propose changes to address identified problems. These include redesigning the physical structure of the ED, more mental health training and support for ED staff, better access to mental health records and crisis plans for adolescents at risk, and improved after-hours mental health services for children and adolescents.
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Affiliation(s)
- Claire Stewart
- Emergency Department and Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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Bartlett R, Herrick CA, Greninger L. Using a System of Care Framework for the Mental Health Treatment of Children and Adolescents. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Goldstein AB, Horwitz SM. Child and adolescent psychiatric emergencies in nonsuicide-specific samples: the state of the research literature. Pediatr Emerg Care 2006; 22:379-84. [PMID: 16714972 DOI: 10.1097/01.pec.0000216565.26123.34] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Since the 1980s, there has been an increase in the frequency with which children and adolescents with psychiatric symptoms present to emergency departments (ED). Recent trend data from the National Hospital Ambulatory Medical Care Survey database suggest that the increase in ED use for mental health concerns is not driven by a rise in the frequency of medically serious suicide attempts but, rather, nonurgent diagnoses. The current paper is a systematic review of the existing research literature on child and adolescent psychiatric emergencies among nonsuicidal samples to assess the type and quality of the data reported. This is a first step in developing a profile of which children, in the absence of medically serious suicide attempt, seek psychiatric care in EDs. METHODS Literature searches were conducted through PsycINFO, MEDLINE, and PubMed databases for the years 1990 through 2004. Twelve studies were identified as meeting inclusion criteria and were reviewed for general study information (ie, bibliography); quality indicators; study characteristics (ie, data source, location of study, method of subject recruitment, and study inclusion/exclusion criteria); subject characteristics, and outcome measures and results (specific outcome assessed, types of data analyses). RESULTS Most of the studies were cross-sectional, retrospective chart reviews, with one data source. Only one study reported on all variables of interest, and there was no consistency in data collection or reporting across studies. CONCLUSIONS Although there has been a documented increase in children and adolescents seeking care for psychiatric emergencies in EDs, a clear and basic understanding of who these patients are cannot be determined from existing published research reports. Significant inconsistencies in data collection and reporting make recommendations for treatment planning and service delivery challenging. A research agenda in the field of child and adolescent psychiatric emergencies is proposed.
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Affiliation(s)
- Amy B Goldstein
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Santiago LI, Tunik MG, Foltin GL, Mojica MA. Children requiring psychiatric consultation in the pediatric emergency department: epidemiology, resource utilization, and complications. Pediatr Emerg Care 2006; 22:85-9. [PMID: 16481922 DOI: 10.1097/01.pec.0000199568.94758.6e] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
METHODS A cohort of children younger than 18 years presenting to an urban pediatric emergency department (PED) who underwent psychiatric consultation was analyzed. A standardized data collection sheet was prospectively completed and included: patient characteristics, extent of medical evaluation and findings, ancillary diagnostic studies, resources utilized, dangerous behaviors, and disposition. RESULTS Two hundred ten patients required psychiatric evaluation. Median age was 14 years; 51.9% were boys; 71.9% had a past psychiatric history; 39.0% had prior psychiatric admission(s), and 40.5% were on psychiatric medications. The admission rate was 49.5%. Patients spent a median of 5.7 hours in the PED. Hospital police monitored 51.9% patients. Forty-five patients had 91 dangerous behaviors. Those patients presenting with a complaint of aggressive behavior (P = 0.00006), a past psychiatric history (P = 0.003), or a history of prior psychiatric hospitalization (P = 0.005) were more likely to have dangerous behaviors. Two hundred nine patients underwent a complete medical evaluation, and 207 were considered medically cleared. Patients who had diagnostic evaluations for medically indicated reasons were significantly more likely to have abnormal results than those requested by the psychiatric consultant for screening purposes (43.6% vs. 9.2%; relative risk, 2.33; 95% confidence interval, 1.33-4.08) but were not statistically more likely to result in medical intervention (5.4% vs. 0%, P = 0.243). CONCLUSIONS PED patients requiring psychiatric consultation and psychiatric admission had a prolonged PED stay and a high incidence of dangerous behaviors requiring intervention. History and physical examination adequately identified medical illness. Laboratory evaluation obtained for psychiatric transfer or admission purposes was of low yield.
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Affiliation(s)
- Lucia I Santiago
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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Goldstein AB, Silverman MAC, Phillips S, Lichenstein R. Mental health visits in a pediatric emergency department and their relationship to the school calendar. Pediatr Emerg Care 2005; 21:653-7. [PMID: 16215467 DOI: 10.1097/01.pec.0000181420.56729.4f] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Over the past decade, there has been a significant increase in the rate at which children and adolescents present to emergency departments (EDs) with mental health complaints. The goal of the current study was to assess the rate of ED usage for children and adolescents and to determine if there was an association between mental health emergencies and the school year. METHODS Retrospective chart review of 719 psychiatric consultations to an urban ED affiliated with an academic medical center. Records of consultations from April 2001 to March 2002 were reviewed and abstracted for variables such as age, sex, time and date of presentation, and psychosocial factors. RESULTS Chi2 analyses reveal significant associations between presentation to the ED for a psychiatric complaint and time of day, day of week, and month of year. One-way analyses of variance also demonstrated mean differences in presentations for day of week and month of year. CONCLUSIONS The current study supports previous research findings of an association between the school year and child and adolescent mental health emergencies. In the current study, the school year appears to exacerbate childhood problems, as there is a greater frequency of psychiatric emergencies while children are in school. Implications for ED program development and school-based mental health service delivery are reviewed.
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Affiliation(s)
- Amy B Goldstein
- Department of Mental Health Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205-1900, USA.
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