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Patients with mental illness triaged appropriately

Patients with mental illness waited less time than other patients to see a physician during crowded periods in the ED, according to study results published in the Canadian Medical Association Journal. These results ran contrary to concerns that people with mental illness are not triaged appropriately.

“Our findings support our belief that triage nurses follow the guidelines, and do not systematically ‘down-triage’ patients with mental illness,” the researchers wrote. “Instead, our results show an increase in high priority triage scores during periods of crowding, which was greater than what occurred for other patients.”

Clare L. Atzema, MD, MSc, assistant professor in the department of medicine at the University of Toronto, and colleagues performed a retrospective cohort analysis of adults seen in 155 EDs across Ontario from 2007 to 2009. The researchers compared the triage scores of patients with mental illness vs. other patients. The triage scores were derived from the Canadian Triage and Acuity Scale. The amount of crowding in the ED was determined by lengths of stay.

Results indicated that the time to assessment by a physician was longer overall for patients with mental illness compared with other patients (median 82 min vs. median 75 min; P<.001). However, time from the decision to admit the patient with mental illness to hospital to ward transfer was shorter (74 min vs. 152 min; P<.001).

In adjusted analyses, the researchers found that patients with mental illness waited 10 minutes longer during less crowded periods (95% CI, 8-11), but waited significantly less than other patients as crowding increased (P<.001). For example, compared with other patients, those with mental illness waited 14 minutes less during mild crowding (95% CI, –12 to –15), 38 minutes less during moderate crowding (95% CI, –35 to –42) and 48 minutes less during severe crowding (95% CI, –39 to –56).

The researchers concluded that strategies similar to Ontario’s Emergency Room Wait Time Strategy will help improve wait times for patients with mental illness.

Disclosure: The researchers reported no relevant financial disclosures.