Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity.
BACKGROUND
An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation-may lead to more external transfers to find care.


METHODS
This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR).


RESULTS
We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06];P=0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60-3.40];P<0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19];P<0.001) were more likely to require transfer and travel farther to access care.


CONCLUSIONS
Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and adults older than 65 years are more likely to require transfer.
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Amy M
AM
O'Neil
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Annie T
AT
Sadosty
Mayo Clinic, Division of Health Care Policy and Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.
Kalyan S
KS
Pasupathy
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Christopher
C
Russi
Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, Minnesota.
Christine M
CM
Lohse
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Ronna L
RL
Campbell
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001509:Bed Occupancy; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011570:Psychiatry; D012189:Retrospective Studies