Resumption of outpatient medications in Emergency Department psychiatric emergencies

Patients presenting to the emergency department (ED) with psychiatric emergencies often experience prolonged lengths of stay (LOS) compared to those with medical or surgical issues. While the Joint Commission recommends early resumption of outpatient psychiatric medications, limited data exists on its impact on ED LOS. This study evaluates whether early psychiatric medication resumption affects ED LOS in this patient population.

We conducted a multi-center, retrospective chart review across three hospitals in central Ohio. Included were patients with underlying psychiatric illness on chronic psychotropic therapy, presenting with a psychiatric emergency, and experiencing ED LOS >24 h. The primary outcome was ED LOS among patients whose medications were resumed within 24 h compared to those resumed after 24 h or not at all.

Of 250 eligible patients, 96 had medications resumed within 24 h, 36 after 24 h, and 118 were never resumed. Baseline demographics were similar, though the early resumption group was older and had higher Medicare coverage. No significant difference in overall ED LOS was observed between early resumption and delayed/no resumption groups (47.7 h vs. 46.4 h, p = 0.98). However, a post-hoc subgroup analysis among patients who had medications resumed showed significantly shorter LOS in the <24 h group compared to the >24 h group (47.7 h vs. 65.7 h, p = 0.0004).

Early psychiatric medication resumption in the ED was not associated with increased LOS or adverse outcomes. Identifying patient subgroups that benefit from early resumption may help reduce ED LOS and improve care efficiency in psychiatric emergencies.