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ED length-of-stay significantly longer for individuals requiring psychiatric care
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Analysis of national data for ED visits between 2002 and 2011 indicated that differences in length-of-stay between individuals with psychiatric and non-psychiatric visits did not decrease over time, suggesting insufficiencies in psychiatric care in the ED.
“Previous research shows that patients in the [ED] often experience lengthy wait times, but our new study shows that psychiatric patients wait disproportionately longer than other patients — sometimes for several hours — only to ultimately be discharged or transferred elsewhere,” Jane M. Zhu, MD, MPP, of the Perelman School of Medicine, University of Pennsylvania, Philadelphia, said in a press release. “Overall, the study highlights the degree to which [EDs] struggle to meet the needs of mental health patients.”
To assess trends in psychiatric-related visits to the ED and compare lengths-of-stay between psychiatric and non-psychiatric visits, researchers conducted a retrospective analysis of data from the National Hospital Ambulatory Medical Care Survey for ED visits between 2002 to 2011. Analysis included 234,094 records, representing 811 million weighted ED visits.
Individuals who made psychiatric visits were more likely to be admitted for hospitalization (17.8% vs. 14.6%), transferred to another facility (9.6% vs. 1.6%), or admitted for observation (2% vs. 1.5%), compared with those without psychiatric visits.
Discharges accounted for 67.1% of psychiatric visits, compared with 82.1% of non-psychiatric visits.
Median length-of-stay in the ED was comparable among psychiatric and non-psychiatric patients admitted to the hospital from the ED (264 minutes vs. 269 minutes).
Among individuals admitted for observation, median length-of-stay was 76 minutes longer for psychiatric visits vs. non-psychiatric visits. Similarly, median lengths-of-stay were longer among individuals with psychiatric visits transferred to another facility (117 minutes vs. 44 minutes).
Among individuals admitted for observation, transferred, or discharged, median, mean and ninetieth-percentile lengths-of-stay were significantly longer for those with psychiatric visits than non-psychiatric visits, according to researchers.
Analysis of ninetieth-percentile measures indicated psychiatric visits were longer than non-psychiatric visits among nearly all years and dispositions. In 2002, the ninetieth-percentile length-of-stay among discharges was 513 minutes for psychiatric visits vs. 325 minutes for other visits. In 2011, psychiatric visits were longer by 149 minutes among those discharged, 835 minutes among those admitted for observation and 269 minutes among those transferred, compared with other visits.
“Lengths-of-stay were significantly longer for psychiatric patients who were discharged, admitted for observation, or transferred to another facility, compared to non-psychiatric patients with similar dispositions. Psychiatric visits also ended in disproportionately higher transfer rates than non-psychiatric visits, with wait times for transfer increasing over the study period,” the researchers wrote. “While it may be true that psychiatric conditions are fundamentally different from medical conditions, these differences in lengths-of-stay underline disparities in access to care for people with mental illnesses. A number of structural and process-related improvements could increase the system’s capacity to care for a growing population with mental health needs.” – by Amanda Oldt
Disclosure: Please see the full study for a list of all authors’ relevant financial disclosures.