title: Management of mental health patients in Victorian emergency departments: A 10 year follow-up study.
abstract: OBJECTIVE
  Despite efforts to restructure mental health (MH) services across Victoria, the social and economic burden of MH illness continues to grow. This study compares MH presentations to EDs with a study undertaken 10 years earlier.
  
  
  METHODS
  The article is a retrospective observational study of MH presentations to four Victorian EDs between May and October 2013. Subjects were included if the presentation was MH related as determined by an International Classification of Diseases (version 10) discharge diagnosis, they were referred to an emergency crisis assessment team or had a documented presenting psychiatric complaint. Variables were extracted from electronic medical records and compared with 2004 data from a previous published study.
  
  
  RESULTS
  There were 5659 MH presentations over the 5 months compared with 2788 in 2004. The median ED length of stay decreased from 4:18 h in 2004 to 3:20 h in 2013 (P < 0.001), with a significant reduction in length of stay >4 h from 52.5% to 35.4% (P < 0.001). There was a 22-fold increase in short stay units as discharge destination from 0.9% to 20.2% (P < 0.001). Patients presenting with concurrent methamphetamine exposure doubled from 2.2% of presentations to 4.3% (P < 0.001).
  
  
  CONCLUSIONS
  Despite increasing MH-related presentations, changes in ED practice have allowed improvements in delivery of care through a shortened ED length of stay and the virtual elimination of very long stays over 24 h. However, there continues to be significant variability in management and performance across hospital sites. Identifying which interventions lead to standout site performance, and subsequent application more broadly, may improve future ED delivery of care.
authors.affiliation: Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Alarcon Manchego
authors.affiliation: Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.|Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Knott
authors.affiliation: Emergency Department, Dandenong Hospital, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Andis
authors.identifier: http://orcid.org/0000-0002-0310-3983
authors.initials: A
authors.lastname: Graudins
authors.affiliation: Emergency Department, Geelong Hospital, Geelong, Victoria, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Bartley
authors.affiliation: Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
keywords: emergency department length of stay; emergency department performance; emergency medicine; emergency psychiatric services; mental health