Psych patients wait 42% longer in ER

Patients with psychiatric emergencies wait an average of 11.5 hours in the emergency department (ED)--42 percent longer than other patients, according to an Annals of Emergency Medicine study published online yesterday.

Researchers looked at the records of nearly 1,100 patients. On average, patients discharged home clocked 8.6 hours in the emergency department, but patients admitted to a psychiatric unit within the hospital stayed 11 hours. (Patients transferred to an outside unit in the local healthcare system stayed 12.9 hours, and those transferred to a facility outside the local system stayed 15 hours.)

Researchers concluded that several factors affect the longer times for psychiatric patients, including a patient's alcohol use on the toxicology screening, which delayed the ED stay, as well as restraint use and completing diagnostic imaging, which tacked on time to post-assessment boarding.

The longer waits for patients with psychiatric emergencies could have significant implications for the ED. Aside from the provider stress, greater risk for adverse events and lower patient satisfaction associated with long waits, lead study author Anthony Weiss of Massachusetts General Hospital in Boston noted that psychiatric visits to EDs more than doubled between 2000 and 2007, growing by 231 percent.

"This increase in volume, when combined with fewer resources outside the ER, have led to a real crisis for this population. Long waits for care aren't good for anyone, but they are especially harmful to patients in psychiatric distress," Weiss said in a research announcement.

The Centers for Medicare & Medicaid Services in March announced the Medicaid Emergency Psychiatric Demonstration, which commits $75 million to 12 states (Alabama, California, Connecticut, Illinois, Maine, Maryland, Missouri, North Carolina, Rhode Island, Washington state, West Virginia and Washington, D.C.) to relieve the strain on general hospitals. The Medicaid Emergency Psychiatric Demonstration will test whether Medicaid reimbursement for treating psychiatric emergencies in institution-for-mental-disease settings will boost quality and cost savings.

For more information:
- see the announcement
- here's the full study (.pdf)

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