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Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments
Jacqueline Grupp-Phelan1, Prashant Mahajan, George L Foltin
1Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45213, USA. grupj0@cchmc.org
Insights
Pediatric emergency departments (EDs) use significant resources for psychiatric visits, especially for suicidal youth. Improved mental health service linkage is needed to reduce ED burden.
Area of Science:
- Pediatric Emergency Medicine
- Child and Adolescent Psychiatry
- Healthcare Resource Utilization
Background:
- Pediatric emergency departments (EDs) manage a growing number of psychiatric-related visits.
- Understanding resource utilization in these visits is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To describe referral patterns and resource use for pediatric psychiatric emergency department visits.
- To identify key areas for intervention to improve care for children with psychiatric conditions in ED settings.
Main Methods:
- Retrospective chart review of psychiatric-related visits in 4 pediatric EDs within a research network.
- Analysis of patient demographics, chief complaints, and ED resource utilization (consultations, restraints, labs, length of stay).
Main Results:
- 462 visits reviewed; common complaints included suicidality, aggression, and anxiety/depression.
- High rates of mental health consultations (90%) and significant ED resource use (5.1-hour length of stay).
- Over half of patients were admitted, primarily to psychiatric beds.
Conclusions:
- Pediatric psychiatric visits place a substantial demand on emergency department resources.
- Interventions are needed to enhance linkage to mental health services, particularly for suicidal adolescents, to alleviate ED burden.
Objective:
To describe the patterns of referral and use of resources for patients with psychiatric-related visits presenting to pediatric emergency departments (EDs) in a pediatric research network.
Methods:
We conducted a retrospective chart review of a random sample of patients (approximately 10 charts per month per site) who presented with psychiatric-related visits in 2002 to 4 pediatric EDs in the Pediatric Emergency Care Applied Research Network. Emergency department resource use variables evaluated included the use of consultation services, restraints, and laboratory tests as well as ED length of stay.
Results:
We reviewed 462 patient visits with a psychiatric-related ED diagnosis. Mean (SD) age was 12.8 (3.7) years, 52% were male, and 49% were African American. The most common chief complaints were suicidality (47%), aggression/agitation (42%), and anxiety/depression (27%), alone or in combination. Ninety percent of patients (range across sites, 83%-94%) had a mental health consult in the ED, 5% were restrained (range, 3%-9%), and 35% had a laboratory test performed (range, 15%-63%). Mean (SD) ED length of stay was 5.1 (5.4) hours, and 52% were admitted (93% to a psychiatric bed, including transfers to separate psychiatric facilities).
Conclusions:
Children with psychiatric-related visits seem to require substantial ED resources. Interventions are needed to reduce the burden on the ED by increasing the linkage to mental health services, particularly for suicidal youths.
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