A study of five urban hospitals showed an average emergency department wait of more than 11 hours for people seeking psychiatric care, according to an article published online in Annals of Emergency Medicine.
While the average wait was 8.2 hours, it was 11 hours or longer for those who were intoxicated, older and uninsured, said lead author Anthony P. Weiss, M.D., of Harvard and Massachusetts General Hospital.
“The results of this study are important because they highlight the interrelatedness of the various components of the mental health system and provide objectively identified targets for quality improvement,” Weiss and co-authors wrote.
“Emergency departments that are embedded within a larger system of care and have ready access to various levels of after-care options … are likely to be better positioned to more rapidly transition patients through the emergency department,” they added.
Weiss and colleagues conducted a prospective study involving two academic and three community hospitals in the Boston area. Each hospital collected data on approximately 200 consecutive patients seeking psychiatric help in its emergency department.
Ultimately, 1,092 patients, with an even distribution between the sexes, were studied. The median age was 39. Non-Hispanic whites made up 71 percent of the sample, two-thirds had public insurance and 13 percent were homeless.
The most common complaints were depression or anxiety (37 percent), suicidal ideation or nonlethal self-harm (33 percent). Drug and alcohol screens were unremarkable 61 percent of the time. Alcohol was the most frequently identified substance (33 percent).
Two hundred and ninety-nine patients were discharged to home and 679 were admitted to the hospital or transferred to a psychiatric unit. The remaining 114 had varying outcomes.
Patients’ wait times extended from 3.3 to 7.4 hours from decision disposition to the end of the emergency department visit.
Approximately two-thirds of all patients receiving emergency mental healthcare in this sample were either admitted or transferred to a psychiatric unit,” the authors added.
“Although these hospitalized patients tended to be seen and assessed more quickly than patients discharged home, they had significantly longer overall length of stay because of the extended wait time between the decision to admit and the emergency department discharge.”
Study limitations include the reliance on chart review rather than direct observation. Results may not apply generally because the study was done at a single system of care in one U.S. region.
Source: Annals of Emergency Medicine