The Impact of Mental Health Services in a Pediatric Emergency Department: The Implications of Having Trained Psychiatric Professionals.
OBJECTIVE
This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED.


METHODS
A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013. These subjects were diagnosed by the ED physician at the time of the visit using codes ranging from 290.0 to 319.0 based on the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes.


RESULTS
The mean (SD) age of children in the postprogram period (14.3 ± 3.1) was younger than during the preprogram period (14.9 ± 3.1) (P < 0.001) with the greatest increase in the 11- to 15-year age group (42% vs 35%, respectively). Patients in the postprogram period were significantly more likely to be discharged to a psychiatric hospital than during the pre-program period (18% vs 9%, respectively). After the initiation of the program, ED length of stay decreased significantly from 14.7 to 12.1 hours (P < 0.001) and costs per visit decreased slightly from US $602 to US $588 (this difference was not statistically significant).


CONCLUSIONS
Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.
From the *Department of Public Health Sciences and the Institute of Family and Neighborhood Life, Clemson University, Clemson; †Department of Psychiatry & Behavioral Medicine, ‡Clinical Services, Department of Psychiatry, and §Quality Management Department, Greenville Health System, Greenville, SC.
Sharon M
SM
Holder
Kenneth
K
Rogers
Eunice
E
Peterson
Robbie
R
Shoenleben
Dawn
D
Blackhurst
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D004637:Emergency Services, Psychiatric / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology*; D008605:Mental Health Services / Q000191:economics*; D010351:Patient Discharge; D011570:Psychiatry / Q000193:education*; D012189:Retrospective Studies