Care plan program reduces the number of visits for challenging psychiatric patients in the ED.
BACKGROUND
A small number of patients representing a significant demand on emergency department (ED) services present regularly for a variety of reasons, including psychiatric or behavioral complaints and lack of access to other services. A care plan program was created as a database of ED high users and patients of concern, as identified by ED staff and approved by program administrators to improve care and mitigate ED strain.


METHODS
A list of medical record numbers was assembled by searching the care plan program database for adult patients initially enrolled between the dates of November 1, 2006, and October 21, 2007. Inclusion criteria were the occurrence of a psychiatric International Classification Diseases, Ninth Revision, code in their medical record and a care plan level implying a serious psychiatric disorder causing harmful behavior. Additional data about these patients were acquired using an indigent care tracking database and electronic medical records. Variables collected from these sources were analyzed for changes before and after program enrollment.


RESULTS
Of 501 patients in the database in the period studied, 48 patients fulfilled the criteria for the cohort. There was a significant reduction in the number of visits to the ED from the year before program enrollment to the year after enrollment (8.9, before; 5.9, after; P < .05). There was also an increase in psychiatric hospital visits (2%, before; 25%, after; P < .05).


CONCLUSIONS
An alert program that identifies challenging ED patients with psychiatric conditions and creates a care plan appears to reduce visits and lead to more appropriate use of other resources.
Texas A&M Health Sciences Center, College of Medicine, Corpus Christi, TX, USA.
Arthur
A
Abello
Ben
B
Brieger
Kim
K
Dear
Ben
B
King
Chris
C
Ziebell
Atheer
A
Ahmed
Truman J
TJ
Milling
D000328:Adult; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010347:Patient Care Planning; D012189:Retrospective Studies