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Organization and function of academic psychiatric emergency services
Glenn W Currier1, Michael Allen
1University of Rochester Medical Center, NY, USA. glenn_currier@urmc.rochester.edu
General Hospital Psychiatry
|April 5, 2003
Summary
Psychiatric emergency services (PES) are complex units providing crucial care. Findings reveal a need for better substance abuse treatment and aftercare coordination to reduce patient recidivism.
Area of Science:
- Emergency Medicine
- Psychiatry
- Healthcare Management
Background:
- Psychiatric emergency services (PES) are increasingly vital components of tertiary care medical centers.
- Their specific services and integration with medical emergency departments require systematic assessment.
Purpose of the Study:
- To examine the structure, care processes, patient characteristics, and inter-service relationships of PES facilities.
- To assess staffing, medical evaluation, length of stay, and aftercare coordination in PES.
Main Methods:
- A 70-item questionnaire was administered to directors of PES facilities in the U.S. in 1998.
- The survey achieved a 91% response rate from 51 facilities, predominantly academic training sites.
Main Results:
- Most PES facilities operated 24/7 with attending psychiatrists present daily.
- Psychiatrists frequently performed medical evaluations and clearance; pharmacologic therapy was common.
- While effective in referrals, 69% reported inadequate substance abuse treatment options, contributing to an 18% recidivism rate.
Conclusions:
- PES facilities are complex, performing medical clearance, initiating treatment, and coordinating aftercare.
- Enhanced medical training for PES psychiatrists, improved aftercare, and better substance abuse treatment access are critical.
- Addressing substance abuse and medication noncompliance is key to reducing recidivism.