Factors related to admission of psychiatric patients to medical wards from the general hospital emergency department: a 3-year study of urgent psychiatric consultations.
OBJECTIVE
Emergency Rooms (ER) of Emergency Departments (ED) in General Hospitals (GH) have a role in providing for psychiatric evaluation. The aims of the present study were to examine the decision-making process of consultation psychiatry at the GH-ER and to analyze the differences between psychiatric patients admitted to a medical ward with those admitted to the psychiatry unit and those who are discharged from the ER.


METHODS
Over a period of 3 years, psychiatric consultations requested by ER of ED physicians to the GH Psychiatric service were recorded by using a form to describe epidemiological and clinical data on the consultation process.


RESULTS
Of 1,962 psychiatric consultations, most regarded subjects who had had previous psychiatric contacts (76.2%) and at least one psychiatric admission (53.6%), and were currently cared for by the Mental Health Services (51.1%). Neurotic/stress-related syndromes (27.98%), schizophrenia (27.67%), and personality disorders (21.81%) were the most frequent ICD-10 diagnoses. The psychiatrist's disposal was to discharge the patient in 49.9% cases, to admit him/her to medical wards of the GH (MGH; 26.9%) or to the acute inpatient psychiatric ward (AIP; 23.1%). MGH group statistically differed from AIP group for being female (p < 0.01), older (p < 0.01), more likely having an ICD-10 diagnosis of neurosis/stress-related syndromes (p < 0.01) or organic mental disorder (p < 0.01), and less likely having a diagnosis of schizophrenia (p < 0.01), being in charge of the Mental Health Services (p < 0.01), and having had previous psychiatric admissions (p < 0.01). These results were confirmed by logistic regression analysis.


CONCLUSIONS
The study shows that the medical wards of the General Hospital are a significant entry-point for providing psychiatric care of patients with ICD-10 neurotic and stress-related syndromes, even if without specific medical problems.
University of Ferrara and Department of Mental Health, Ferrara, Italy.
Bruno
B
Biancosino
Adello
A
Vanni
Luciana
L
Marmai
Spyridon
S
Zotos
Luana
L
Peron
Claudio
C
Marangoni
Vanessa
V
Magri
Luigi
L
Grassi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D007558:Italy; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D010343:Patient Admission; D011567:Psychiatric Department, Hospital; D012017:Referral and Consultation; D012959:Socioeconomic Factors; D055815:Young Adult