title: Impact of a psychiatric unit's daily discharge rates on emergency department flow.
abstract: OBJECTIVE
  To investigate relationships between time spent in the emergency department (ED) in patients requiring admission to the psychiatric ward, the day of the week of presentation and the daily number of discharges from the psychiatric ward.
  
  
  METHODS
  Retrospective analysis of patient flow as a function of day of week, time of day (a.m., p.m.), number of patients requiring admission and number of ward discharges over a one-year period, for all mental health related presentations to the ED of the Queen Elizabeth Hospital in Adelaide, South Australia, before their admission to the psychiatric inpatient facility.
  
  
  RESULTS
  The time spent by patients in the ED waiting for admission to the psychiatric ward was significantly greater on weekends. There were significantly fewer discharges from the psychiatric ward during weekends compared with weekdays. The average time spent by patients in the ED requiring admission to the psychiatric ward for those days when there were vacant beds was 17.9 hours (SD=14.5). More people presented to the ED with a psychiatric diagnosis in the afternoons. There was a significant inverse correlation between the time spent by patients in the ED requiring admission to the psychiatric ward per day and the number of discharges from the psychiatric ward per day.
  
  
  CONCLUSIONS
  These findings demonstrate that patient flow is significantly slower on weekends because of fewer discharges from the ward, leading to longer times spent in the ED before ward transfer. Waiting times in the ED were very substantially greater than the proposed 4-hour target even when vacant beds were available, raising considerable doubt about that target being realistic for psychiatric patients.
authors.affiliation: Discipline of Psychiatry, University of Adelaide, Adelaide, Australia. tarun.bastiampillai@health.sa.gov.au
authors.forename: Tarun
authors.initials: T
authors.lastname: Bastiampillai
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Schrader
authors.forename: Rohan
authors.initials: R
authors.lastname: Dhillon
authors.forename: Jörg
authors.initials: J
authors.lastname: Strobel
authors.forename: Niranjan
authors.initials: N
authors.lastname: Bidargaddi
mesh_terms: D000328:Adult; D017598:Efficiency, Organizational; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013021:South Australia; D013997:Time Factors; D014850:Waiting Lists