Characterization of Older Emergency Department Patients Admitted to Psychiatric Units.
BACKGROUND
Many older patients presenting to emergency departments (EDs) with psychiatric complaints require admission to geropsychiatric units (GPUs). The medical evaluation needed prior to this is not understood. Our goal was to understand ED evaluation practices for patients admitted to the GPU through the ED and understand the medical problems identified after admission.


METHODS
Via retrospective chart review, we abstracted demographics, medical history, ED complaint, evaluation, length of stay, and diagnosis. The number of patients later transferred from the GPU and the reasons for such transfers were also recorded.


RESULTS
Of 100 patients reviewed, the average age was 78 years. Admission diagnoses were agitation/mania (30%), depression/suicidal ideation (28%), change in mental status/confusion (12%) and other (30%). Most had at least one prior psychiatric and medical diagnosis (77%, 60%). Common ED tests ordered were basic metabolic panel (BMP) (96%), complete blood count (CBC) (94%), urinalysis (UA) (89%), electrocardiogram (EKG) (69%), alcohol level (62%), urine toxicology (61%), chest X-ray (51%), and CT scan of the head (71%). Abnormal findings included urinalysis (24.7%), CBC (23.4%), toxicology (23%), BMP (21.9%), head CT (21.1%), chest X-ray (13.7%), ECG changes (10.1%), and alcohol (4.8%). Five of the 100 GPU admissions were later transferred to a medical floor.


CONCLUSIONS
Most GPU admissions have previous psychiatric and medical issues and are admitted for agitation/mania or depression/suicidal ideation. A certain percentage of patients are transferred out due to medical issues despite ED evaluation. However, it is unlikely that further ED testing would reduce this percentage. Further research of medical screening for geropsychiatric patients may elucidate ideal medical clearance procedures.
Department of Emergency Medicine, Summa Akron City Hospital, 525 East Market Street, Akron, OH 44304, USA ; Department of Emergency Medicine, Northeast Ohio Medical University, 4209 State Rte 44, Rootstown, OH 44272, USA.
Kirk A
KA
Stiffler
Department of Emergency Medicine, Summa Akron City Hospital, 525 East Market Street, Akron, OH 44304, USA.
Erol
E
Kohli
Department of Emergency Medicine, Summa Akron City Hospital, 525 East Market Street, Akron, OH 44304, USA.
Oriana
O
Chen
Department of Emergency Medicine, Summa Akron City Hospital, 525 East Market Street, Akron, OH 44304, USA.
Jennifer A
JA
Frey
Emergency medicine; Geriatric; Psychiatry; Screening