Hours and miles: Patient and health system implications of transfer for psychiatric bed capacity

Amy M. O'Neil, Annie T. Sadosty, Kalyan S Pasupathy, Christopher Russi, Christine M. Lohse, Ronna L. Campbell

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)783-790
Number of pages8
JournalWestern Journal of Emergency Medicine
Volume17
Issue number6
DOIs
StatePublished - 2016

Fingerprint

Psychiatry
Hospital Emergency Service
Health
Odds Ratio
Inpatients
Length of Stay
Electronic Health Records
Logistic Models
Suicidal Ideation
Health Resources
Tertiary Healthcare
Documentation
Cohort Studies
Referral and Consultation
Retrospective Studies
Demography

Keywords

  • Bed capacity
  • Emergency medicine
  • Overcrowding
  • Patient transfer
  • Psychiatric acute care

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Hours and miles : Patient and health system implications of transfer for psychiatric bed capacity. / O'Neil, Amy M.; Sadosty, Annie T.; Pasupathy, Kalyan S; Russi, Christopher; Lohse, Christine M.; Campbell, Ronna L.

In: Western Journal of Emergency Medicine, Vol. 17, No. 6, 2016, p. 783-790.

Research output: Contribution to journalArticle

O'Neil, Amy M. ; Sadosty, Annie T. ; Pasupathy, Kalyan S ; Russi, Christopher ; Lohse, Christine M. ; Campbell, Ronna L. / Hours and miles : Patient and health system implications of transfer for psychiatric bed capacity. In: Western Journal of Emergency Medicine. 2016 ; Vol. 17, No. 6. pp. 783-790.
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abstract = "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.",
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AU - O'Neil, Amy M.

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AU - Russi, Christopher

AU - Lohse, Christine M.

AU - Campbell, Ronna L.

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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.

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