Variation in admission rates between psychiatrists on call in a university teaching hospital

Hospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. We endeavoured to understand clinician-related factors that influence the decision to admit.

We retrospectively examined data collected between August 1, 2013 and July 31, 2015 for patients triaged as mental health assessments in the emergency department of a university teaching hospital. We identified 1530 unique cases who had been reviewed by the staff psychiatrist for a decision on whether to admit to an acute care bed. Patient and physician characteristics were analyzed by standard descriptive methods, comparative statistics (Chi square and analysis of variance) and regression analyses using SPSS version 24.0 (IBM Corp. Armonk, NY, USA).

There were no differences in patient characteristics in the clinical encounters reviewed by different staff psychiatrists. The physician factor found significant in deciding whether to admit the patient was assignment to PES (psychiatric emergency services). This appeared to be the only physician variable impacting the decision to admit a patient with PES psychiatrists admitting less often than their colleagues (p = 0.018, Table 3). The effect size of the variable in terms of odds ratio was 0.592.

Training and practice in emergency psychiatry lead to lower admission rates when these clinicians are on call. Training in emergency psychiatry for all psychiatrists participating in a call pool may result in lowered admission rates.