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Predictors of Psychiatric Boarding in the Emergency Department

INTRODUCTION: The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychi...

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Autores principales: Misek, Ryan K., DeBarba, Ashley E., Brill, April
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Department of Emergency Medicine, University of California, Irvine School of Medicine 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307730/
https://www.ncbi.nlm.nih.gov/pubmed/25671012
http://dx.doi.org/10.5811/westjem.2014.10.23011
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author Misek, Ryan K.
DeBarba, Ashley E.
Brill, April
author_facet Misek, Ryan K.
DeBarba, Ashley E.
Brill, April
author_sort Misek, Ryan K.
collection PubMed
description INTRODUCTION: The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments (EDs) nationwide. Boarding is recognized as a major cause of ambulance diversions and ED crowding and has a significant adverse impact on healthcare providers, patient satisfaction, and hospital costs. We sought to identify differences between patients who boarded versus patients who did not board, to identify factors amenable to change and identify interventions that could lead to a decrease in overall psychiatric patient length of stay and improve patient care. METHODS: This study is a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs in Illinois from July 1, 2010 through June 30, 2012. We identified 671 patients and collected insurance status, sex, age, time of arrival, time of disposition and time of transfer. RESULTS: There was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to non-boarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients who were boarded in the ED, compared to 71.8% of Medicare/Medicaid patients and 78.3% of patients with private insurance (χ(2)=50.6, df=2, p<0.001). We found the length of stay to be longer for patients transferred to publicly funded psychiatric facilities compared to those transferred to private facilities, with a mean time spent in the ED of 1,661 minutes and 705 minutes, respectively (p<0.001). Patients with Medicare/Medicaid were nearly twice as likely to return to the ED for psychiatric emergencies than self-pay and privately insured patients, requiring repeat inpatient psychiatric admission (estimate=0.649, p=0.035, OR=1.914). CONCLUSION: This study found that unfunded patients boarded significantly longer than Medicare/Medicaid and privately insured patients. Patients with private insurance boarded longer than those with Medicare/Medicaid. Patients transferred to publicly funded facilities had significantly longer ED length of stay than patients transferred to private facilities.
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spelling pubmed-43077302015-02-10 Predictors of Psychiatric Boarding in the Emergency Department Misek, Ryan K. DeBarba, Ashley E. Brill, April West J Emerg Med Behavioral Health INTRODUCTION: The emergency psychiatric care is system is overburdened in the United States. Patients experiencing psychiatric emergencies often require resources not available at the initial treating facility and frequently require transfer to an appropriate psychiatric facility. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments (EDs) nationwide. Boarding is recognized as a major cause of ambulance diversions and ED crowding and has a significant adverse impact on healthcare providers, patient satisfaction, and hospital costs. We sought to identify differences between patients who boarded versus patients who did not board, to identify factors amenable to change and identify interventions that could lead to a decrease in overall psychiatric patient length of stay and improve patient care. METHODS: This study is a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs in Illinois from July 1, 2010 through June 30, 2012. We identified 671 patients and collected insurance status, sex, age, time of arrival, time of disposition and time of transfer. RESULTS: There was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to non-boarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients who were boarded in the ED, compared to 71.8% of Medicare/Medicaid patients and 78.3% of patients with private insurance (χ(2)=50.6, df=2, p<0.001). We found the length of stay to be longer for patients transferred to publicly funded psychiatric facilities compared to those transferred to private facilities, with a mean time spent in the ED of 1,661 minutes and 705 minutes, respectively (p<0.001). Patients with Medicare/Medicaid were nearly twice as likely to return to the ED for psychiatric emergencies than self-pay and privately insured patients, requiring repeat inpatient psychiatric admission (estimate=0.649, p=0.035, OR=1.914). CONCLUSION: This study found that unfunded patients boarded significantly longer than Medicare/Medicaid and privately insured patients. Patients with private insurance boarded longer than those with Medicare/Medicaid. Patients transferred to publicly funded facilities had significantly longer ED length of stay than patients transferred to private facilities. Department of Emergency Medicine, University of California, Irvine School of Medicine 2015-01 2014-11-26 /pmc/articles/PMC4307730/ /pubmed/25671012 http://dx.doi.org/10.5811/westjem.2014.10.23011 Text en Copyright © 2015 the authors. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/.
spellingShingle Behavioral Health
Misek, Ryan K.
DeBarba, Ashley E.
Brill, April
Predictors of Psychiatric Boarding in the Emergency Department
title Predictors of Psychiatric Boarding in the Emergency Department
title_full Predictors of Psychiatric Boarding in the Emergency Department
title_fullStr Predictors of Psychiatric Boarding in the Emergency Department
title_full_unstemmed Predictors of Psychiatric Boarding in the Emergency Department
title_short Predictors of Psychiatric Boarding in the Emergency Department
title_sort predictors of psychiatric boarding in the emergency department
topic Behavioral Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307730/
https://www.ncbi.nlm.nih.gov/pubmed/25671012
http://dx.doi.org/10.5811/westjem.2014.10.23011
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