title: Prolonged length of stay in ED psychiatric patients: a multivariable predictive model.
abstract: BACKGROUND
  We aimed to evaluate factors associated with prolonged emergency department (ED) length of stay (LOS) among psychiatric patients and to develop a multivariable predictive model to guide future interventions to reduce ED LOS.
  
  
  METHODS
  Electronic health records of ED patients receiving a psychiatric consultation and providing research authorization were reviewed from September 14, 2010, through September 13, 2013, at an academic hospital with approximately 73000 visits annually. Prolonged LOS was defined as ≥8 hours.
  
  
  RESULTS
  We identified 9247 visits among 6335 patients; median LOS was 4.1 hours, with 1424 visits (15%) with prolonged LOS. In the multivariable model, characteristics associated with an increased risk of a prolonged LOS included patient age 12 to 17 years (odds ratio [OR], 2.43; P<.001) or ≥65 years (OR, 1.46; P=.007); male gender (OR, 1.24; P=.002); Medicare insurance coverage (OR, 1.34; P=.008); use of restraints (OR, 2.25; P=.006); diagnoses of cognitive disorder (OR, 4.62; P<.001) or personality disorder (OR, 3.45; P<.001); transfer to an unaffiliated psychiatric hospital (OR, 22.82; P<.001); ED arrival from 11 pm through 6:59 am (OR, 1.53; P<.001) or on a Sunday (OR, 1.76; P<.001); or ED evaluation in February (OR, 1.59; P=.006), April (OR, 1.66; P=.002), and May (OR, 1.54; P=.007).
  
  
  CONCLUSIONS
  Many psychiatric patients had a prolonged ED LOS. Understanding the multiple, patient-specific, ED operational, and seasonal factors that predict an increased LOS will help guide allocation of resources to improve overall ED processes and patient care.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Warren
authors.affiliation: Department of Emergency, Mayo Clinic, Rochester, MN.
authors.forename: Ronna L
authors.initials: RL
authors.lastname: Campbell
authors.affiliation: Department of Emergency, Mayo Clinic, Rochester, MN.
authors.forename: David M
authors.initials: DM
authors.lastname: Nestler
authors.affiliation: Division of Health Care Policy and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Kalyan S
authors.initials: KS
authors.lastname: Pasupathy
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Emergency, Mayo Clinic, Rochester, MN.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Koch
authors.affiliation: Department of Emergency, Mayo Clinic, Rochester, MN.
authors.forename: Eduard
authors.initials: E
authors.lastname: Schlechtinger
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Schmidt
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN. Electronic address: melin.gabrielle@mayo.edu.
authors.forename: Gabrielle J
authors.initials: GJ
authors.lastname: Melin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012621:Seasons