Factors Associated With Length of Stay in Emergency Departments for Pediatric Patients With Psychiatric Problems

Mental health help-seeking behaviours among children and young people from culturally and linguistically diverse communities in a multicultural urban Australian population

OBJECTIVE

This study aimed to investigate the help-seeking behaviours among children and young people (CYP) from culturally and linguistically diverse (CALD) backgrounds for mental health (MH) needs in a multicultural Australian population.

METHODS

We analysed the electronic medical records (eMR) of 8135 MH-related emergency department (ED) encounters of CYP aged up to 18 years across six public hospitals in the South Western Sydney Local Health District, Australia, from January 2016 to April 2022. Urgency of MH care was grouped into high priority (triage categories 1 and 2, needing to have treatment within 10 minutes) and low-to-moderate (triage categories 3-5, needing to have treatment within 30-120 minutes) presentations. Multilevel logistic regression models adjusted for key covariates and patient level clustering examined the relationship between CALD status and urgency of MH care. We also assessed the combined effects of gender and CALD status, as well as CALD status and residential area socioeconomic status, on urgent ED care.

RESULTS

About 8.3% of all MH-related ED presentations during the 6-year period were classified as high priority. The odds of high-priority MH ED care were 2.03-fold higher for CALD CYPs compared to non-CALD CYPs (adjusted odds ratio (AOR): 2.03, 95% confidence interval [CI] = [1.46-2.82]). Furthermore, an added increase in the odds of seeking urgent MH care for CYPs who belong to multiple risk groups was observed among CALD male CYPs (AOR: 2.96, 95% CI = [1.81-4.85]) and those living in disadvantaged areas (AOR: 2.36, 95% CI = [1.59-3.49]).

CONCLUSION

The findings of this study highlight the need for culturally appropriate services aimed at prevention and early intervention targeted at CYP from CALD backgrounds to avoid crisis presentations.

Prolonged length of stay among individuals presenting to the emergency department with psychosis: Associations with sociodemographic and visit-level characteristics

INTRODUCTION

Individuals experiencing psychosis commonly initiate and engage in treatment within an emergency department (ED) setting. Understanding factors contributing to adverse ED experiences is critical for improving psychosis-related treatment. Prolonged ED length of stay (LOS), which can be conversely associated with treatment quality, is not well explored among individuals experiencing psychosis.

METHODS

In this retrospective analysis of 2129 ED visits for psychosis, we examined sociodemographic characteristics associated with prolonged ED LOS. Among these visits, which occurred from March 1, 2019-February 28, 2021, we also examined the risk of physical restraint, parenteral medication administration, disposition to inpatient psychiatric hospitalization, and substance use positivity by prolonged ED LOS status.

RESULTS

Females, compared to males, were more likely to have prolonged ED LOS; no other sociodemographic characteristics were significantly associated with prolonged ED LOS. Visits with physical restraint, parenteral medication administration, and disposition to inpatient psychiatric hospitalization had a greater risk of prolonged ED LOS compared to visits without these factors.

CONCLUSIONS

These findings provide critical insight on approaches to reduce ED LOS among individuals experiencing psychosis and improve treatment engagement.

The Impact of Child and Adolescent Inpatient Psychiatric Admissions Out-of-Area or to Adult Wards: A Systematic Review

Aims/Background Child and adolescent psychiatric inpatient admissions out-of-area or to adult wards are frequently discussed in the national media. No previous systematic reviews have investigated the impact of such admissions. Methods Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, PsycArticles, King's Fund, Google Scholar, The Health Foundation, Social Care Online, Cochrane Library, Royal College of Psychiatrists, Web of Science and Econ light databases were conducted alongside grey literature searches. All eligible studies investigating the impact of acute psychiatric inpatient admission out-of-area or to adult wards in children and adolescents were included. Risk of bias was assessed using an adapted version of the Hawker critical appraisal tool. Results 18 studies were included (4 reported on out-of-area admissions, 13 on adult ward admissions, 1 study reported on both). Study quality was variable. Out-of-area admission impacts included longer emergency department waits, higher travel costs for families, and were described as 'time-inefficient'. For studies of admissions of under-18s to adult psychiatric wards the most commonly reported impact was on length of stay. Opinions from staff and young people of these types of admissions were mostly negative. Conclusion Further studies looking at the full range of impacts of these admissions over the long term are needed.

Addressing the Multidimensional Aspects of Trauma in Emergency Department Boarding for Neurodiverse Youth

Psychiatric boarding in pediatric emergency departments is a predictable outcome of escalating psychiatric acuity and inadequate mental health services in hospital systems and the community at large. Guidelines are offered to support initiating treatments in nonpsychiatric hospital settings to reduce pediatric boarding. Treatments call for interdisciplinary approaches, care coordination, and addressing systemic disparities in access and quality of care. Telemental health interventions offer a promising means of reducing inequalities in access. Creating a crisis continuum of care will help minimize strict reliance on inpatient settings, which are increasingly challenging to access and only sometimes fully address the crises, even when used.

Mental Health Crisis Responses and (In)Justice: Intrasystem and Intersystem Implications

Mental health crises among people who are marginalized merit special consideration. These groups are both overserved and underserved by mental health crisis systems: over-represented in acute treatment settings by number while facing inequities in outcomes. The predisposing, precipitating, and perpetuating factors that contribute to crises, however, neither begin nor end with the mental health system. Rather, these factors are multisystemic. As an illustration of this concept, this article highlights select marginalized groups, those that have faced inequities in mental health diagnosis and treatment due to race, medical complexity, age, and criminal justice system involvement.

Association of Race/Ethnicity and Social Determinants with Rehospitalization for Mental Health Conditions at Acute Care Children's Hospitals

OBJECTIVE

To evaluate associations of race/ethnicity and social determinants with 90-day rehospitalization for mental health conditions to acute care nonpsychiatric children's hospitals.

STUDY DESIGN

We conducted a retrospective cohort analysis of mental health hospitalizations for children aged 5-18 years from 2016 to 2018 at 32 freestanding US children's hospitals using the Children's Hospital Association's Pediatric Health Information System database to assess the association of race/ethnicity and social determinants (insurance payer, neighborhood median household income, and rurality of patient home location) with 90-day rehospitalization. Risk factors for rehospitalization were modeled using mixed-effects multivariable logistic regression.

RESULTS

Among 23 556 index hospitalizations, there were 1382 mental health rehospitalizations (5.9%) within 90 days. Non-Hispanic Black children were 26% more likely to be rehospitalized than non-Hispanic White children (aOR 1.26, 95% CI 1.08-1.48). Those with government insurance were 18% more likely to be rehospitalized than those with private insurance (aOR 1.18, 95% CI 1.04-1.34). In contrast, those living in a suburban location were 22% less likely to be rehospitalized than those living in an urban location (suburban: aOR 0.78, 95% CI 0.63-0.97).

CONCLUSIONS

Non-Hispanic Black children and those with public insurance were at greatest risk for 90-day rehospitalization, and risk was lower in those residing in suburban locations. Future work should focus on upstream interventions that will best attenuate social disparities to promote equity in pediatric mental healthcare.

Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015)

BACKGROUND AND OBJECTIVES

Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits.

METHODS

We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression.

RESULTS

From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type.

CONCLUSIONS

The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.

Which Factors Predict Hospital Length-of-Stay for Children Admitted to the Neonatal Intensive Care Unit and Pediatric Ward? A Hospital-Based Prospective Study

Background. The ability to accurately predict hospital length of stay (LOS) or time to discharge could aid in resource planning, stimulate quality improvement activities, and provide evidence for future research and medical practice. This study aimed to determine the predictive factors of time to discharge among patients admitted to the neonatal intensive care unit (NICU) and pediatric ward in Goba referral hospital, Ethiopia. Methods. A facility-based prospective follow up study was conducted for 8 months among 438 patients. Survival analyses were carried out using the Kaplan Meier statistics and Cox regression model. Results. The median length of hospital stay was 7 days (95% confidence interval (CI): 6.45-7.54) and 6 days (95% CI: 5.21-6.78) for patients admitted to NICU and pediatric ward, respectively. In the multivariable Cox regression, the hazard of neonatal patients with less than 37 weeks of gestational age, low birth weight, and those who develop hospital-acquired infection (HAI) after admission had prolonged time to discharge by 54% [adjusted hazard ratio (AHR): 0.46, (95% CI: 0.31-0.66)], 40% [AHR: 0.60, (95% CI: 0.40-0.90)], and 56% [AHR: 0.44, (95% CI: 0.26-0.74)], respectively. The rate of time to discharge among patients who were admitted to the pediatric ward and had HAI delayed discharge time by 49% [AHR: 0.51, (95% CI: 0.30-0.85)] compared to their counterparts. Conclusion. Hospital-acquired infections prolonged hospital stay among neonates and children admitted to the pediatric ward. On a similar note, low gestational age and low birth weight were found to be the independent predictor of longer hospital stay among neonates.