Involuntary admissions to the emergency department: a retrospective observational study

Area of Science:

• Emergency Medicine
• Psychiatry
• Public Health

Background:

• Involuntary admission to emergency departments is a critical measure for patient assessment.
• Understanding the characteristics and outcomes of these admissions is vital for healthcare system evaluation.

Purpose of the Study:

• To describe the demographics, diagnoses, and outcomes of patients involuntarily admitted to the Lausanne University Hospital emergency department in 2018.
• To analyze the length of stay and disposition of patients under involuntary admission.
• To evaluate the confirmation rate of involuntary admissions after emergency department assessment.

Main Methods:

• Retrospective, observational, monocentric study of adult patients (≥18 years) with involuntary admissions.
• Data extracted from hospital databases and electronic records for the year 2018.
• Descriptive statistics used to analyze patient characteristics, length of stay, and diagnoses.

Main Results:

• 83 patients were involuntarily admitted, predominantly male (58%) with a mean age of 55 years.
• Common diagnoses included psychiatric disorders (schizophrenia) and substance use disorders; 50% used psychoactive substances (mainly alcohol).
• Median emergency department length of stay was 9-16 hours for confirmed involuntary admissions, compared to 6 hours overall. Only one-third of admissions were confirmed post-assessment.

Conclusions:

• Involuntary emergency department admissions are frequently discontinued, indicating potential overuse or inappropriate application of the measure.
• Primary care physicians may lack alternatives, leading to emergency department use for initial assessment.
• The findings highlight a need to optimize pathways for patients requiring psychiatric or substance use evaluations outside of emergency settings.