Clinical factors related to admission and release decisions in psychiatric emergency services
ABSTRACT 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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ABSTRACT: Patients who repeatedly injure themselves present particular management problems for general psychiatric teams. This article, the first of a series of four, examines the characteristics of those that present to adult mental health services, and the possible underlying background and trigger factors that lead to these anxiety-raising events. Suggestions are made on preventive and assessment procedures, staff reactions and management strategies aimed at helping patients deal with the overwhelming feelings that underlie self-injury.Advances in Psychiatric Treatment 05/2006; 12(3):193-201. DOI:10.1192/apt.12.3.193
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ABSTRACT: We analyzed the dispositional decisions taken in a unit for clinical decision making (UCDM) which was set up to examine all emergency inpatient referrals to a psychiatric hospital. Hospitalization proved unnecessary for at least 17 % of the N = 2,026 inpatient referrals over a one year period. Instead, these patients were admitted to day-hospitals or outpatient treatments, resulting in annual cost savings of approximately 3.3 million. Merely 8 % of those non-admitted patients had to be hospitalized within 28 days of the decision for non-admission being taken. Thus, a specialized UCDM run by clinical experts can help identify cost-effective alternatives to hospitalization.Administration and Policy in Mental Health and Mental Health Services Research 06/2014; DOI:10.1007/s10488-014-0561-5 · 3.44 Impact Factor
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ABSTRACT: Background: Mental health patients can experience long lengths of stay in the emergency department (ED). Reducing boarding times for mental health patients might improve care for all ED patients. Objective: The objective of this study was to identify patient factors that are correlated with extremely long lengths of stay (EL-LOS) for mental health patients in the ED. Methods: A retrospective, case-control study compared mental health patients experiencing lengths of stay longer than 24 h to those with lengths of stay <24 h. The study was conducted at an urban, academic ED and Level I trauma center. Sequential chi-squared tests were used to detect significant differences on the outcome measure. Logistic regression was used to determine factors that made significant contributions to predicting EL-LOS. The outcome measure was patients' length of stay in the ED. The factors analyzed were patient demographics, insurance status, day of arrival and departure, placement (admitted locally, admitted remotely, or discharged), chief complaint, and diagnostic category. Results: Patient-level factors associated with EL-LOS were self-pay status, admission to inpatient care, transfer to a remote facility, and suicidal ideation. Admission to inpatient care and self-pay status made significant nonredundant contributions to predicting EL-LOS. In addition, mental health patients arriving on a wweekday were significantly more likely to be admitted to inpatient care than those arriving on weekends. Conclusions: Factors were identified that correlatedwith long lengths of stay in the ED for mental health patients. Increasing timely access to inpatient beds for mental health patients, in particular by improving access to insurance that covers inpatient psychiatric care and eliminating unique mental health requirements to obtain prior authorization for placement, would likely reduce these patients' lengths of stay. (C) 2014 Elsevier Inc.Journal of Emergency Medicine 07/2014; 47(4). DOI:10.1016/j.jemermed.2014.04.040 · 1.18 Impact Factor