title: Predictors of Prolonged Length of Stay and Adverse Events among Older Adults with Behavioral Health-Related Emergency Department Visits: A Systematic Medical Record Review.
abstract: BACKGROUND
  Behavioral health (BH)-related visits to the emergency department (ED) by older adults are increasing. This population has unique challenges to providing quality, timely care.
  
  
  OBJECTIVE
  To characterize older adults with BH-related ED visits and determine risk factors associated with prolonged length of stay (LOS) and adverse events (AEs).
  
  
  METHODS
  We performed a retrospective electronic health record review of all patients ≥65 years who presented to our ED from September 2011 to August 2012 for BH-related complaints. Sociodemographic, clinical, and utilization data were tested for association with LOS and AE.
  
  
  RESULTS
  The 213 elder BH patients represented 4% of the 5267 total elder visits during the study period. Median age was 75 (interquartile range [IQR] 70-82); largely white (84.5%), female (58.7%), and non-Hispanic (69.5%). There was a median of two comorbidities (IQR 1-3), and 46.9% were cognitively impaired. Most (71.5%) were being evaluated on an involuntary basis. Median LOS was 16.2 h (IQR 9.7-29.7). Increased LOS was associated with involuntary status (12.4 h, 95% confidence interval [95% CI] 6.4-18.4); use of restraints (11.9 h, 95% CI 5.7-18.2); and failed discharge (28.8 h, 95% CI 21.2-36.6). For every 10 additional hours in the ED, the risk for an AEs (p = .002) or potential AEs (p = .01) increased 20%.
  
  
  CONCLUSIONS
  Elderly ED patients with BH complaints had high rates of cognitive impairment and multiple comorbidities. LOS was prolonged, and there were multiple contributing factors including involuntary status, chemical or physical restraint, and failed discharge. Patients with longer LOS were at increased risk of an AE or potentially AEs.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona.
authors.forename: Suzanne Michelle
authors.initials: SM
authors.lastname: Rhodes
authors.affiliation: College of Pharmacy, The University of Arizona, Tucson, Arizona.
authors.forename: Asad E
authors.initials: AE
authors.lastname: Patanwala
authors.affiliation: College of Medicine, The University of Arizona, Tucson, Arizona.
authors.forename: Julia Katherine
authors.initials: JK
authors.lastname: Cremer
authors.affiliation: College of Medicine, The University of Arizona, Tucson, Arizona.
authors.forename: Erica Siovhan
authors.initials: ES
authors.lastname: Marshburn
authors.affiliation: Department of Pharmacy, Providence St Peters Hospital, Olympia, Washington.
authors.forename: Michael
authors.initials: M
authors.lastname: Herman
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Poison & Drug Information Center, College of Pharmacy, The University of Arizona, Tucson, Arizona; Center for Toxicology Pharmacology Education and Research, College of Medicine, The University of Arizona, Phoenix, Arizona.
authors.forename: Farshad Mazda
authors.initials: FM
authors.lastname: Shirazi
authors.affiliation: Arizona Center on Aging, The University of Arizona, Tucson, Arizona; Department of Psychiatry, College of Medicine, The University of Arizona, Tucson, Arizona.
authors.forename: Patricia
authors.initials: P
authors.lastname: Harrison-Monroe
authors.affiliation: Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wendel
authors.affiliation: Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona.
authors.forename: Mindy
authors.initials: M
authors.lastname: Fain
authors.affiliation: Division of Geriatrics, General Medicine, and Palliative Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; Arizona Center on Aging, The University of Arizona, Tucson, Arizona.
authors.forename: Jane
authors.initials: J
authors.lastname: Mohler
authors.affiliation: Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, Arizona; College of Medicine, The University of Arizona, Tucson, Arizona.
authors.forename: Arthur B
authors.initials: AB
authors.lastname: Sanders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors
keywords: adverse events; boarding; emergency; geriatric psychiatry; length of stay