Emergency Medicine

Psychiatric emergency services vary widely in hospital emergency departments

Ten percent of emergency department (ED) visits nationwide are psychiatric emergencies. However, very few emergency physicians and nurses are trained to handle psychiatric emergencies. A growing number of hospitals are creating psychiatric consultation services within hospital EDs, but the psychiatric emergency services (PESs) they offer vary widely, reveals a study supported by the Agency for Healthcare Research and Quality (HS13859).

Jennifer Field Brown, M.S.N., Ph.D., of Norfolk State University, retrospectively examined the psychiatric consultation arrangements and outcomes of hospitals that had EDs in the year 2000. She used models to test the extent to which organizational and environmental characteristics influenced service arrangement and hospital-level outcomes. Another model examined the influence of the PES arrangement on patient outcomes. The study was conducted using data from the States of Maryland and South Carolina, the American Hospital Association, Area Resource File, and a hospital administrator survey about hospital PES arrangements and performance.

A total of 71 hospitals responded to the survey, with 45 percent indicating they had an in-house arrangement for PES; 41 percent had market contracting; and 14 percent had no PES. In-house arrangements were associated with decreased ED readmission rates. However, patient outcome was best predicted by a combination of the PES arrangement and personal characteristics. Patient disposition (discharge or hospital admission) was the only outcome for which organizational influences were more significant. Dr. Brown recommends in-house EDPES for hospitals that have any of the following conditions: a high frequency of psychiatric cases in the ED, a patient population that is low-income and high-acuity, and payer sources that provide relatively lower reimbursement for services.

See "Emergency department psychiatric consultation arrangement," by Dr. Brown, in the July 2005 Health Care Management Review 30(3), pp. 251-261.

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