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Factors Associated with Extended Length of Stay for Patients Presenting to an Urban Psychiatric Emergency Service: A Case-Control Study

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Abstract

This study assessed factors associated with extended length of stay (ELOS) for patients presenting to a psychiatric emergency service (PES). Two hundred six subjects with a length of stay of 24 h or longer were compared with time-matched controls (patients that presented directly after the ELOS patient). Binary logistic regression was used to identify risk factors for ELOS. ELOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Lack of insurance, suicidal ideation, disposition to inpatient unit, and homicidal ideation all made nonredundant contributions to predicting stays of 24 h or longer.

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References

  1. Larkin GL, Claassen CA, Emond JA, et al. Trends in US emergency department visits for mental health conditions, 1992 to 2001. Psychiatric Services. 2005;56(6):671–677 doi:10.1176/appi.ps.56.6.671.

    Article  PubMed  Google Scholar 

  2. Gerson S, Bassuk E. Psychiatric emergencies: an overview. American Journal of Psychiatry. 1980;137(1):1–11.

    PubMed  CAS  Google Scholar 

  3. Mazandi Iseke RJ. Improving emergency department flow. In: Rosen RA, ed. Managing to Get it Right: The ACEP User’s Guide to Emergency Department Management. Dallas, TX: American College of Emergency Physicians; 1998:79–88.

    Google Scholar 

  4. Magaret ND, Clark TA, Warden CR, et al. Patient satisfaction in the emergency department: a survey of pediatric patients and their parents. Academic Emergency Medicine. 2002;9(12):1379–1388.

    PubMed  Google Scholar 

  5. Bindman AB, Grumbach K, Keane D, et al. Consequences of queuing for care at a public hospital emergency department. Journal of the American Medical Association. 1991;266(8):1123–1125 doi:10.1001/jama.266.8.1091.

    Article  Google Scholar 

  6. Derlet R, Richards J. Overcrowding in the nations’ emergency departments: complex causes and disturbing effects. Annals of Emergency Medicine. 2000;35:63–68 doi:10.1016/S0196-0644(00)70105-3.

    Article  PubMed  CAS  Google Scholar 

  7. Kennedy J, Rhodes K, Walls CA, et al. Access to emergency care: restricted by long waiting times and cost and coverage concerns. Annals of Emergency Medicine. 2004;43(5):567–573 doi:10.1016/j.annemergmed.2003.10.012.

    Article  PubMed  Google Scholar 

  8. Roper JM, Manela J. Psychiatric patients’ perceptions of waiting time in the psychiatric emergency service. Journal of Psychosocial Nursing and Mental Health Services. 2000;38(5):18–27.

    PubMed  CAS  Google Scholar 

  9. Currier GW, Allen M. Organization and function of academic psychiatric emergency services. General Hospital Psychiatry. 2003;25:124–129 doi:10.1016/S0163-8343(02)00287-6.

    Article  PubMed  Google Scholar 

  10. Breslow RE, Klinger BI, Erickson BJ. Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service. General Hospital Psychiatry. 1996;18:183–191 doi:10.1016/0163-8343(96)00019-9.

    Article  PubMed  CAS  Google Scholar 

  11. Breslow RE, Klinger BI, Erickson BJ. Time study of psychiatric emergency service evaluations. General Hospital Psychiatry. 1997;19:1–4 doi:10.1016/S0163-8343(96)00117-X.

    Article  PubMed  CAS  Google Scholar 

  12. Kropp S, Andreis C, te Wildt B, et al. Psychiatric patients’ turnaround times in the emergency department. Clinical Practice and Epidemiology in Mental Health. 2005;1:27 doi:10.1186/1745-0179-1-27.

    Article  PubMed  Google Scholar 

  13. Arfken CL, Zeman LL, Yeager L, et al. Case-control study of frequent visitors to an urban psychiatric emergency service. Psychiatric Services. 2004;55:295–301 doi:10.1176/appi.ps.55.3.295.

    Article  PubMed  Google Scholar 

  14. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Archives of General Psychiatry. 1994;51(1):8–19.

    PubMed  CAS  Google Scholar 

  15. Kringlen E, Rorgersen S, Cramer V. A Norwegian psychiatric epidemiological study. American Journal of Psychiatry. 2001;158(7):1091–1098 doi:10.1176/appi.ajp.158.7.1091.

    Article  PubMed  CAS  Google Scholar 

  16. Lee TW, Renaud EF, Hills OF. An emergency treatment hub-and-spoke model for psychiatric emergency services. Psychiatric Services. 2003;54(12):1590–1594 doi:10.1176/appi.ps.54.12.1590.

    Article  PubMed  Google Scholar 

  17. Catalano R, McConnell W, Forster P, et al. Psychiatric emergency services and the system of care. Psychiatric Services. 2003;54:351–355 doi:10.1176/appi.ps.54.3.351.

    Article  PubMed  Google Scholar 

  18. McAlpine DD, Mechanic D. Utilization of specialty mental health care among persons with severe mental illness: The roles of demographics, need, insurance, and risk. Health Services Research. 2000;35(1, Pt 2):277–292.

    PubMed  CAS  Google Scholar 

  19. Shi L, Stevens GD. Vulnerability and unmet health care needs. Journal of General Internal Medicine. 2005;20(2):148–154 doi:10.1111/j.1525-1497.2005.40136.x.

    Article  PubMed  Google Scholar 

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Disclosures

Author no. 1 (LTP) participates in psychiatric research funded by Abbott, Janssen, Pfizer, Cyberonics, Medtronic and Aspect. Author no. 3 (CJS) participates in pharmaceutical research funded by Abbott, Janssen, and Pfizer. The other authors have no disclosures.

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Correspondence to Jennifer M. Park MD.

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Park, J.M., Park, L.T., Siefert, C.J. et al. Factors Associated with Extended Length of Stay for Patients Presenting to an Urban Psychiatric Emergency Service: A Case-Control Study. J Behav Health Serv Res 36, 300–308 (2009). https://doi.org/10.1007/s11414-008-9160-0

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  • DOI: https://doi.org/10.1007/s11414-008-9160-0

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