title: Characteristics of adult psychiatric patients with stays of 24 hours or more in the emergency department.
abstract: OBJECTIVE
  This study identified characteristics of adult psychiatric patients who remained for 24 or more hours in the emergency departments of general hospitals in Massachusetts.
  
  
  METHODS
  Data were collected starting in June 2008 on a prospective cohort of 1,076 patients who presented for emergency psychiatric evaluation at one of five hospitals.
  
  
  RESULTS
  A total of 90 patients (8%) stayed 24 or more hours (median=31 hours). More than 90% (N=1,018) of all patients had health insurance. Characteristics associated with extended stays included homelessness, transfer to another hospital, public insurance, and use of restraints or sitters (p<.05). The two academic medical centers had higher proportions of extended-stay patients than the three community hospitals (12% and 15% versus 1%, 7%, and 7%, respectively; p<.001).
  
  
  CONCLUSIONS
  Despite overall high rates of health insurance coverage, publicly insured patients waited longer than those with private insurance. Future reforms of Massachusetts' mandatory health insurance program should consider treatment capacity as well.
authors.affiliation: Department of Psychiatry, Department of Veterans Affairs Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA. grace.chang2@va.gov
authors.forename: Grace
authors.initials: G
authors.lastname: Chang
authors.forename: Anthony
authors.initials: A
authors.lastname: Weiss
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Kosowsky
authors.forename: Endel John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Smallwood
authors.forename: Scott L
authors.initials: SL
authors.lastname: Rauch
mesh_terms: D000328:Adult; D000374:Aggression; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D010360:Patient Transfer; D059020:Suicidal Ideation; D013997:Time Factors