Factors associated with involuntary return to a psychiatric emergency service within 12 months.
OBJECTIVE
This study examined patient characteristics and other factors that contributed to the involuntary return of patients to a psychiatric emergency service within 12 months of an initial evaluation in the service. The findings were used to consider whether the pressure to limit duration of hospital stays under managed care contributed to the patients' return to the emergency service.


METHODS
Structured observations of evaluations of 417 patients admitted to the psychiatric emergency service were completed at seven county general hospitals in California. Twelve months after the initial evaluation, mental health and criminal justice records were reviewed for evidence of the patients' return for emergency psychiatric evaluation at any of the seven hospitals. Factors associated with patients' return to the psychiatric emergency service were evaluated using multivariate modeling.


RESULTS
Of the 417 patients initially evaluated, 121, or 29 percent, were involuntarily returned to the psychiatric emergency service within 12 months. The likelihood of involuntary return was increased by a psychotic diagnosis and indications of dangerousness at the initial evaluation. Having insurance also increased the likelihood of involuntary return.


CONCLUSIONS
The patient's initial condition in the psychiatric emergency service was found to be the best predictor of involuntary return. Brief hospitalization--an average of six days--after the evaluation did not have a significant prophylactic effect, perhaps because the reduced length of inpatient stay in the managed care environment did not allow adequate resolution of the patient's clinical condition.
Segal
S P
SP
Mental Health and Social Welfare Research Group in the School of Social Welfare at the University of California, Berkeley 94720-7400, USA. spsegal@uclink4.berkeley.edu
Akutsu
P D
PD
Watson
M A
MA
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D003419:Crisis Intervention / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy; D012008:Recurrence; D012308:Risk Management / Q000706:statistics & numerical data; D012495:San Francisco / Q000453:epidemiology; D012720:Severity of Illness Index; D013223:Statistics as Topic; D014754:Violence / Q000706:statistics & numerical data