TY - JOUR
T1 - Hours and miles
T2 - Patient and health system implications of transfer for psychiatric bed capacity
AU - O'Neil, Amy M.
AU - Sadosty, Annie T.
AU - Pasupathy, Kalyan S.
AU - Russi, Christopher
AU - Lohse, Christine M.
AU - Campbell, Ronna L.
N1 - Publisher Copyright:
© 2016 Mayo Foundation for Medical Education and Research.
PY - 2016
Y1 - 2016
N2 - Introduction: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation may lead to more external transfers to find care. Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR). Results: We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06]; P=0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60- 3.40]; P<0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P<0.001) were more likely to require transfer and travel farther to access care. Conclusion: Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and adults older than 65 years are more likely to require transfer.
AB - Introduction: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation may lead to more external transfers to find care. Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary care academic ED from February 1, 2013, through January 31, 2014. Patients were identified through electronic health record documentation of psychiatric consultation during ED evaluation. We reviewed electronic health records for demographic characteristics, diagnoses, payer source, ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for inpatient admission. Univariable and multivariable associations with transfer to an external facility in comparison with patients admitted internally were evaluated with logistic regression models and summarized with odds ratios (OR). Results: We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502 patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95% CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR] [95% CI], 1.93 [1.22-3.06]; P=0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60- 3.40]; P<0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P<0.001) were more likely to require transfer and travel farther to access care. Conclusion: Patients requiring external transfer for inpatient psychiatric care were found to have prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and adults older than 65 years are more likely to require transfer.
KW - Bed capacity
KW - Emergency medicine
KW - Overcrowding
KW - Patient transfer
KW - Psychiatric acute care
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U2 - 10.5811/westjem.2016.9.30443
DO - 10.5811/westjem.2016.9.30443
M3 - Article
C2 - 27833689
AN - SCOPUS:84995479997
SN - 1936-900X
VL - 17
SP - 783
EP - 790
JO - Western Journal of Emergency Medicine
JF - Western Journal of Emergency Medicine
IS - 6
ER -