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Home > Library > Annotated Journal Abstracts > 2016 Q4: Emergency Psychiatry

Annotated Abstracts of Journal Articles
2016, 4th Quarter

Emergency Psychiatry

Annotations by Naomi Schmelzer, MD MPH
January 2017

  1. Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions
  2. Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms
PUBLICATION #1 — Emergency Psychiatry
Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions
Hamilton JE, Desai PV, Hoot NR, Gearing RE, Jeong S, et al
Acad Emerg Med 2016; 23(11):1257-1266

The finding: The hospitalization rate of all behavioral health-related ED visits across 16 hospitals was found to be 15%. Together, enabling factors (health insurance status, ED LOS, community-based behavioral service availability, and mode of arrival to the ED) accounted for more of the variability in hospitalization than predisposing (demographic) or need-based (behavioral health diagnosis, alcohol and substance use disorders) factors. Older age, increased ED LOS, arrival by ambulance, co-occuring suicidal ideation and behavior, and diagnoses of schizophrenia or other psychotic disorder, affective disorder or personality disorder all increased the likelihood of hospitalization following an ED visit. Factors that decreased the odds of hospitalization included African American and Hispanic ethnicity, uninsured status, availability of community-based behavioral health services within 5 miles of the ED, and the diagnosis of an anxiety disorder.

Strength and weaknesses: This large multi-site retrospective cohort study adapted the existing Anderson Healthcare Utilization Model to examine predictors of inpatient psychiatric hospitalization among a population presenting for behavioral health visits to a network of EDs within a county in Texas. This is a commonly used framework for systematically categorizing an array of health indicators but has its limitations, such as that it cannot determine causation or detect potential interactions between factors. The study identified and expanded upon a set of factors from the literature, placed them in a framework to predict the likelihood of hospitalization, and hypothesized how these findings could be used to improve the delivery of behavioral health care.

Relevance: With the rise of behavioral health-related ED visits, and the ED being the predominant point of entry for psychiatric hospitalizations, further understanding the factors associated with inpatient admissions can lead to strategies for improving care for these patients as well as resource utilization for emergency psychiatric services.

PUBLICATION #2 — Emergency Psychiatry
Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms
Silwanowicz RM, Maust DT, Seyfried LS, Chiang C, Stano C, Kales HC
Int J Geriatr Psychiatry 2016; Oct 4 [Epub ahead of print]

The finding: In this study investigating the how the presence of neuropsychiatric symptoms affect the provision of ED care for patients with a dementia diagnosis, multiple demographic, clinical, management and disposition factors were assessed. Neuropsychiatric symptoms (NPS) in this population led to increased likelihood of psychotropic medication administration, particularly when motor disturbances were present. Additionally, patients in the NPS group were more likely to be accompanied and/or referred to the ED by a family member and less likely to be discharged to their pre-ED setting than the non-NPS group. Notably, the presence of agitation was not significantly related to hospital admission, medication administration or transfer between care settings. Additional characteristics of the NPS were also identified.

Strength and weaknesses: This is a retrospective cohort study evaluating patients at a single tertiary care academic medical center who presented to either the medical or psychiatric emergency room with a diagnosis of dementia, comparing characteristics of those with and without neuropsychiatric symptoms. One concern was the potential variability in the initial inclusion criteria for dementia (with potential inclusion of only more severe cases) as well as variability in the identification and/or documentation of neuropsychiatric symptoms.

Relevance: Patients with dementia are commonly seen in the emergency department, with presentations often complicated by neuropsychiatric symptoms. An increased understanding of this population’s needs is beneficial when developing care practices.

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