Trends in the Duration of Emergency Department Visits, 2001–2006
Department of Psychiatry, School of Medicine, University of Maryland, Room 526, Baltimore, MD 21201, USA. Psychiatric services (Washington, D.C.)
(Impact Factor: 2.41).
09/2010; 61(9):878-84. DOI: 10.1176/appi.ps.61.9.878
This study estimated trends in the duration of emergency department visits from 2001 to 2006 and compared duration by presenting complaint-mental health related or non-mental health related.
Data on visits (N=193,077) were from the National Hospital Ambulatory Medical Care Survey Emergency Department databases. Visits were classified as mental health visits if the primary reason for the visit was a common mental health symptom or disorder, a problem related to substance use, suicidal behaviors, or a need for counseling. Regression models were adjusted for year, diagnosis type, discharge status, payment source, demographic characteristics, receipt of medical care during the visit, mode of arrival, and immediacy of need for treatment.
The duration of all emergency department visits increased at an annual rate of 2.3%. Trends were similar for mental health visits and non-mental health visits. Throughout the period the average duration of mental health visits exceeded the average duration of non-mental health visits by 42% (p<.001). This difference was related to the longer durations of mental health visits ending in transfer and visits by persons with serious mental illness or substance use disorders.
From 2001 to 2006, the duration of emergency department visits made by patients presenting with mental health complaints and visits made by all other patients increased at similar rates. However, the longer visits for certain groups of mental health patients suggest that emergency departments incur higher costs in connection with the delivery of services to persons in need of acute stabilization.
Available from: Michael P Wilson
- "However, psychiatric patients appear to contribute disproportionately to ED overcrowding. Psychiatry patients experience longer treatment times in the ED compared to nonpsychiatric patients regardless of acuity level     , despite the fact that deleterious effects of extended lengths of stay (LOSs) have been well documented for both psychiatric and nonpsychiatric patients    . Thus, ED LOS for psychiatric patients is an important concern. "
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ABSTRACT: Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS.
A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS.
Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends.
Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.
Copyright © 2015 Elsevier Inc. All rights reserved.
American Journal of Emergency Medicine 01/2015; 33(4). DOI:10.1016/j.ajem.2015.01.017 · 1.27 Impact Factor
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Mental health substance abuse (MHSA)-related visits in the emergency department (ED) are a growing concern.
This study analyzed MHSA ED visits by age, gender, ethnicity, region, season, and duration of stay between 2002 and 2008 using the National Hospital Ambulatory Care Survey (NHAMCS). The authors used descriptive statistics and examined ED length of stay using a generalized linear model with a log link, and compared length of stay for these visits.
Mental health-related visits increased from 6.4% of visits in 2002 to 7.0% in 2008 (P = .002). Substance abuse-related visits increased from 1.8% to 2.1% (P = .004). Substance abuse-related visits accounted for a 49% increase (CI = 0.051-0.23%) in the total mental health visits to the ED. Male visits increased whereas female visits remained unchanged, with non-Latino white males showing the highest increase. The southern United States had the highest increase in MHSA visits. MHSA visits (5.6 hours) were on average 1.2 hours longer than other non-MHSA-related visits (4.4 hours). MHSA-related visits had a higher percentage of all visits on weekends (2.3%) than on weekdays (2.0%; P < .00005).
Concentrated programmatic efforts to decrease the burden of MHSA visits to the ED may reduce the burden of disease.
Substance Abuse 07/2013; 34(3):292-297. DOI:10.1080/08897077.2013.775999 · 1.62 Impact Factor
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ABSTRACT: Optimization techniques are applied to feedrate and voltage control in order to improve performance of biaxial contouring systems. This is done by maintaining contour error within a prescribed tolerance while tracking the trajectory in minimum time. In addition to the error constraint, the current and voltage constraints are required to keep the motors from overloading. The design of the controllers requires two steps. First, an LQR-type innerloop controller for the armature voltage is designed for each axis to assure stability using a performance index that penalizes current, armature voltage, and axial error. Next, nonlinear programming techniques are used to find the outerloop control or feedrate profile (which determines the tracking time) and the weighting matrices (which determine the innerloop controller gains) subject to voltage, current, and two-dimensional contour error constraints for a given trajectory. Although the innerloop controllers are originally designed to minimize a weighted sum of axial error, current, and voltage, the outerloop optimization of the feedrate takes into account the two-dimensional contour error explicitly. In this manner, it is possible to tune the controllers to a particular trajectory to achieve the best performance. The method is tested via simulation using a model of a representative biaxial DC motor contouring system for an elliptical trajectory.
American Control Conference, 1989; 07/1989
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