Prolonged length of stay in ED psychiatric patients: A multivariable predictive model

Background We aimed to evaluate factors associated with prolonged emergency department (ED) length of stay (LOS) among psychiatric patients and to develop a multivariable predictive model to guide future interventions to reduce ED LOS. Methods Electronic health records of ED patients receiving a psychiatric consultation and providing research authorization were reviewed from September 14, 2010, through September 13, 2013, at an academic hospital with approximately 73 000 visits annually. Prolonged LOS was defined as ≥ 8 hours. Results We identified 9247 visits among 6335 patients; median LOS was 4.1 hours, with 1424 visits (15%) with prolonged LOS. In the multivariable model, characteristics associated with an increased risk of a prolonged LOS included patient age 12 to 17 years (odds ratio [OR], 2.43; P <.001) or ≥ 65 years (OR, 1.46; P =.007); male gender (OR, 1.24; P =.002); Medicare insurance coverage (OR, 1.34; P =.008); use of restraints (OR, 2.25; P =.006); diagnoses of cognitive disorder (OR, 4.62; P <.001) or personality disorder (OR, 3.45; P <.001); transfer to an unaffiliated psychiatric hospital (OR, 22.82; P <.001); ED arrival from 11 pm through 6:59 am (OR, 1.53; P <.001) or on a Sunday (OR, 1.76; P <.001); or ED evaluation in February (OR, 1.59; P =.006), April (OR, 1.66; P =.002), and May (OR, 1.54; P =.007). Conclusions Many psychiatric patients had a prolonged ED LOS. Understanding the multiple, patient-specific, ED operational, and seasonal factors that predict an increased LOS will help guide allocation of resources to improve overall ED processes and patient care.