Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002-11.
Despite increases in the use of emergency department (EDs) for mental health care, there are limited data on whether psychiatric patients disproportionately contribute to ED crowding. We conducted a retrospective analysis using a national database of ED visits in the period 2002-11 to describe trends in median and ninetieth-percentile length-of-stay for patients with psychiatric versus nonpsychiatric primary diagnoses. Psychiatric patients who visited the ED were transferred to another facility at six times the rate of nonpsychiatric patients. Median lengths-of-stay were similar for psychiatric and nonpsychiatric patients among those who were admitted to the hospital (264 versus 269 minutes) but significantly different for those who were admitted for observation (355 versus 279 minutes), transferred (312 versus 195 minutes), or discharged (189 versus 144 minutes). Overall, differences in ED length-of-stay between psychiatric and nonpsychiatric patients did not narrow over time. These findings suggest deficiencies in ED capacity for psychiatric care, which may necessitate improvements in both throughput and alternative models of care.
Jane M. Zhu (zhuja@upenn.edu) is a National Clinician Scholar in the Division of General Internal Medicine at the Perelman School of Medicine and a fellow at the Leonard Davis Institute of Health Economics, both at the University of Pennsylvania, in Philadelphia.
Jane M
JM
Zhu
Astha Singhal is an assistant professor of health policy and health services research in the Henry M. Goldman School of Dental Medicine at Boston University, in Massachusetts.
Astha
A
Singhal
Renee Y. Hsia is a professor in the Department of Emergency Medicine and at the Philip R. Lee Institute for Health Policy Studies, both at the University of California, San Francisco.
Renee Y
RY
Hsia
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; 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 / Q000628:therapy*; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D055815:Young Adult
Access To Care; Disparities; emergency department; length of stay; psychiatric