title: The Effect of a Dedicated Psychiatric Team to Pediatric Emergency Mental Health Care.
abstract: BACKGROUND
  Pediatric emergency department (PED) visits among children and adolescents with acute mental health needs have increased over the past decade with long wait times in the PED awaiting disposition.
  
  
  OBJECTIVE
  The objective of this study was to evaluate the effect of a new pediatric mental health liaison program with the hypothesis that this model reduces length of stay (LOS) and hospitalization rates among pediatric mental health patients.
  
  
  METHODS
  This was a pre- and postintervention retrospective study of the year prior to (June 2012-June 2013) and the year after (October 2013-October 2014) implementation of a new PED psychiatric team. All patients aged 1-18 years with a mental health International Classification of Diseases-9(th) Revision code were included. Patients who did not receive a Psychiatry consult in the PED were excluded.
  
  
  RESULTS
  There were 83 encounters in the year prior to and 129 encounters in the year after the implementation of the liaison program. There was an increase in the suicidality of mental health patients during this time. There was a significant decrease in mean PED LOS of 27% (95% confidence interval [CI] 0-46%; p = 0.05) from pre- to postintervention period. The decrease in the proportion of patients admitted/transferred to an inpatient psychiatric facility in the postintervention year was statistically significant (odds ratio 0.35; 95% CI 0.17-0.71; p < 0.01).
  
  
  CONCLUSIONS
  The use of a dedicated child psychiatrist and mental health social worker to the PED results in significantly decreased LOS and need for admission without any change in return visit rate. Larger, multicenter studies are needed to confirm these findings.
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: David C
authors.initials: DC
authors.lastname: Sheridan
authors.affiliation: Department of Care Management/Social Work, Oregon Health & Science University, Portland, Oregon.
authors.forename: John
authors.initials: J
authors.lastname: Sheridan
authors.affiliation: Department of Child & Adolescent Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Johnson
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon; Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Amber
authors.initials: A
authors.lastname: Laurie
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Allyson
authors.initials: A
authors.lastname: Knapper
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon; Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Shannon
authors.initials: S
authors.lastname: Appy
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration*; D016017:Odds Ratio; D010372:Pediatrics / Q000458:organization & administration*; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013405:Suicide / Q000706:statistics & numerical data; D014481:United States
keywords: acute; child; emergency department; mental