title: Lengths of stay for involuntarily held psychiatric patients in the ED are affected by both patient characteristics and medication use.
abstract: BACKGROUND
  Psychiatric patients experience longer treatment times (length of stay [LOS]) in the emergency department (ED) compared to nonpsychiatric patients. Although patients on involuntary mental health holds are relatively understudied, common wisdom would hold that times for these patients can only be affected by addressing systems issues because they are not free to leave. The objective of this study was to determine whether both selected ED and patient-specific factors were associated with longer LOS. We hypothesized that nonmodifiable factors (age, sex, agitation, presentation during evenings/nights, presentation during weekends, suicidal ideation) would prolong LOS but that potentially modifiable factors (such as use of medication) would reduce LOS.
  
  
  METHODS
  A historical cohort of patients (January 1, 2009-August 16, 2010) placed on involuntary mental health holds was studied in 2 general EDs. A regression model was used to calculate the effects of modifiable and nonmodifiable factors on LOS.
  
  
  RESULTS
  Six hundred forty patient visits met all inclusion/exclusion criteria. Longer LOSs were significantly associated with suicidal ideation, use of antipsychotics, and use of benzodiazepines, although agitation did not predict longer LOSs. Longer LOSs were also longer with presentation on the weekends.
  
  
  CONCLUSIONS
  Lengths of stay for patients on involuntary mental health holds are associated with several factors outside the control of the typical ED clinician such as the ability to clear holds quickly due to day of week or placement of the hold for suicidal ideation. Lengths of stay are also increased by factors within the control of the typical ED clinician, such as administration of calming medication.
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA; Department of Emergency Medicine, University of California San Diego, San Diego, CA. Electronic address: mpwilso1@gmail.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA; Department of Emergency Medicine, University of California San Diego, San Diego, CA.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Brennan
authors.affiliation: Department of Emergency Medicine, University of California San Diego, San Diego, CA.
authors.forename: Lucia
authors.initials: L
authors.lastname: Modesti
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA.
authors.forename: James
authors.initials: J
authors.lastname: Deen
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA.
authors.forename: Laura
authors.initials: L
authors.lastname: Anderson
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA; Department of Emergency Medicine, University of California San Diego, San Diego, CA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.affiliation: Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab, University of California San Diego, San Diego, CA; Department of Emergency Medicine, University of California San Diego, San Diego, CA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
mesh_terms: D000328:Adult; D000367:Age Factors; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000628:therapy*; D011595:Psychomotor Agitation; D012307:Risk Factors; D012737:Sex Factors; D059020:Suicidal Ideation
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines