Utilization Patterns at a Specialized Children's Comprehensive Psychiatric Emergency Program.

Area of Science:

• Child and Adolescent Psychiatry
• Emergency Medicine
• Mental Health Services Research

Background:

• Emergency departments (EDs) often lack specialized staff to manage pediatric psychiatric crises.
• This leads to inadequate assessment and treatment for youth in psychiatric emergencies.
• Specialized EDs may improve identification and management of these critical cases.

Purpose of the Study:

• To describe clinical details and patient disposition for psychiatric emergencies in a specialized ED.
• To evaluate the impact of 24/7 child psychiatrist staffing on patient outcomes.
• To understand factors influencing disposition decisions for pediatric psychiatric visits.

Main Methods:

• Retrospective chart review of 1,180 visits to a specialized ED over its first year.
• Analysis of clinical characteristics, prior service use, and demographics.
• Bivariate analyses and multinomial logistic regression to compare disposition outcomes.

Main Results:

• 59% of visits resulted in evaluation and release, 13% in brief stabilization, and 28% in inpatient psychiatric admission.
• Youth with mood/psychotic disorders, current suicidality, or aggression had higher admission rates.
• Aggression often co-occurred with suicidality or self-harm behaviors.

Conclusions:

• Clinical factors, particularly suicidality, were strong predictors of psychiatric admission.
• Higher admission rates for suicidal youth suggest improved risk ascertainment in specialized EDs.
• Dedicated child psychiatrist staffing in EDs may enhance the identification and mitigation of suicide risk.