title: Biopsychosocial health care needs at the emergency room: challenge of complexity.
abstract: BACKGROUND
  In an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment.
  
  
  METHODS
  During a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment.
  
  
  RESULTS
  Study participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters.
  
  
  CONCLUSIONS
  A standardized screening of biopsychosocial case complexity among 'frequent utilizers' of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.
authors.affiliation: Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria.
authors.forename: Franziska
authors.initials: F
authors.lastname: Matzer
authors.forename: Ursula V
authors.initials: UV
authors.lastname: Wisiak
authors.forename: Monika
authors.initials: M
authors.lastname: Graninger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Söllner
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Stilling
authors.forename: Monika
authors.initials: M
authors.lastname: Glawischnig-Goschnik
authors.forename: Andreas
authors.initials: A
authors.lastname: Lueger
authors.forename: Christian
authors.initials: C
authors.lastname: Fazekas
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D004635:Emergency Medicine / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009729:Nursing / Q000379:methods; D011584:Psychology; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014218:Triage / Q000379:methods