Clinical Factors Related to Admission and Release Decisions in Psychiatric Emergency Services

University of Massachusetts Amherst, Amherst Center, Massachusetts, United States
Psychiatric Services (Impact Factor: 2.41). 03/2001; 52(2):214-8. DOI: 10.1176/
Source: PubMed


The purpose of the study was to identify important clinical variables that influence admission and release decisions in psychiatric emergency services.
Physicians at four urban psychiatric emergency services rated 465 patients on ten clinical dimensions, including depression and psychosis. Information on five other variables-age, gender, ethnicity, diagnosis, and previous inpatient admission-were extracted from the patients' charts, as was information on case disposition.
Logistic regression produced a model with five variables that significantly predicted admission or release. In order of importance, they were level of danger to self, severity of psychosis, ability to care for self, impulse control, and severity of depression. The model explained 51 percent of the variance in case disposition and correctly classified 84 percent of the cases.
Guidelines addressing the variables that should be considered in making disposition decisions in psychiatric emergency services should be developed. The study found five variables that should be considered for inclusion.

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    • "Individual demographic characteristics, including ethnicity and age, have also been associated with inpatient admission practices, although with mixed results (Goldberg et al. 2007; Unick et al. 2011). Social variables associated with a greater likelihood of inpatient admission include the presence of family members in the emergency department and poor community functioning (Slagg 1993; Rabinowitz et al. 1995; Mattioni et al. 1999; Way & Banks 2001). "
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    ABSTRACT: Background Individuals with intellectual disabilities (ID) are disproportionately high users of psychiatric emergency services. Despite the demand for psychiatric assessments in the emergency department (ED), no clear guidelines have been established as to what factors should guide clinical decision-making processes. The current study aimed to explore individual, social and contextual factors related to psychiatric care outcomes among patients with ID in the emergency department.Method Emergency department charts were reviewed for 66 individuals with ID who visited the emergency department during a psychiatric crisis.ResultsStandardised crisis severity scores were significantly higher in patients seen by psychiatrists as compared with patients who did not receive psychiatric consultations in the emergency department. A significantly greater proportion of patients with moderate or severe levels of ID (vs. borderline/mild) received psychiatric consultations. Emergency department visits resulting in inpatient hospital admission did not differ from those that did not, with the exception of the level of ID: patients admitted to psychiatric inpatient care were more likely to have moderate or severe levels of ID.Conclusions The psychiatric care experiences of patients with ID in the emergency department appear highly variable. Further research focused on emergency department clinical decision-making practices concerning this population is warranted.
    Journal of Intellectual Disability Research 06/2015; DOI:10.1111/jir.12201 · 2.41 Impact Factor
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    • "To further support this theory, a recent report showed that African Americans tend to receive less psychosocial interventions after being discharged from the hospital after a psychotic episode (Goulding et al. 2010). Without appropriate culturally sensitive services for African Americans, this could perpetuate the ongoing observed cycle of increased grave disability, psychosis and repetitive hospitalizations (Way and Banks 2001). Future interventions need to explore other factors that may be associated with ethnicity and decompensation of psychiatric symptoms in rural border communities. "
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    Community Mental Health Journal 10/2010; 48(2):133-7. DOI:10.1007/s10597-010-9350-0 · 1.03 Impact Factor
    • "A crucial step is the identification of risk factors easily observed and recorded during routine clinical assessment (Troisi et al., 2003). Excitement has been reported as a type of disruptive behaviour frequently associated with danger to self and others in previous studies (Steinert et al., 2005; Oluwatayo and Gater, 2004; Way and Banks, 2001). According to Colasanti et al. (2008), CA is an obvious correlate of excitement and aggression. "
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    Progress in Neuro-Psychopharmacology and Biological Psychiatry 10/2010; 35(1):137-45. DOI:10.1016/j.pnpbp.2010.10.005 · 3.69 Impact Factor
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