Evaluating psychiatric readmissions in the emergency department of a large public hospital

David W Morris,1 Subroto Ghose,1,2 Ella Williams,1,2 Kevin Brown,1,2 Fuad Khan1,2 1Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Department of Psychiatry, Parkland Memorial Hospital, Dallas, TX, USA Introduction: Hospital emergency departments (ED...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Morris DW, Ghose S, Williams E, Brown K, Khan F
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://doaj.org/article/3ae61b7842d94809a90fe49af0899c9b
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:3ae61b7842d94809a90fe49af0899c9b
record_format dspace
spelling oai:doaj.org-article:3ae61b7842d94809a90fe49af0899c9b2021-12-02T02:52:19ZEvaluating psychiatric readmissions in the emergency department of a large public hospital1178-2021https://doaj.org/article/3ae61b7842d94809a90fe49af0899c9b2018-03-01T00:00:00Zhttps://www.dovepress.com/evaluating-psychiatric-readmissions-in-the-emergency-department-of-a-l-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021David W Morris,1 Subroto Ghose,1,2 Ella Williams,1,2 Kevin Brown,1,2 Fuad Khan1,2 1Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Department of Psychiatry, Parkland Memorial Hospital, Dallas, TX, USA Introduction: Hospital emergency departments (EDs) around the country are being challenged by an ever-increasing volume of patients seeking psychiatric services. This manuscript describes a study performed to identify internal and external factors contributing to repeated psychiatric patient admissions to the hospital main ED. Methods: Data from ED visits of patients who were admitted to the Parkland Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a psychiatric complaint more than once within a 30-day period were evaluated (n=202). A 50-item readmission survey was used to collect information on demographic and clinical factors associated with 30-day readmission, as well as to identify quality improvement opportunities by assessing related moderating factors. An analysis of acute readmission visits (occurring within 3 days of previous discharge) was also performed. Results: Patients readmitted to the ED commonly present with a combination of acute psychiatric symptoms, substance use (especially in the case of acute readmission), and violent or suicidal behavior. The vast majority of cases reviewed found that readmitted patients had difficulties coordinating care outside the ED. A number of moderating factors were identified and targeted for quality improvement including additional support for filling prescriptions, transportation, communication with family and outside providers, drug and alcohol treatment, intensive case management, and housing. Conclusion: Many of the resources necessary to reduce psychiatric patient visits to hospital EDs are available within the community. There is no formal method of integrating and insuring the continuity of community services that may reduce the demand for psychiatric and related services in the ED. While agreements between community service providers may be challenging and require considerable vigilance to maintain equitable agreements between parties, this route of improving efficiency may be the only available method, given the current and projected patient care needs. Keywords: chronic mental illness, psychiatric readmission, emergency psychiatry, public mental healthMorris DWGhose SWilliams EBrown KKhan FDove Medical PressarticleChronic mental illnesspsychiatric readmissionemergency psychiatrypublic mental healthNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 14, Pp 671-679 (2018)
institution DOAJ
collection DOAJ
language EN
topic Chronic mental illness
psychiatric readmission
emergency psychiatry
public mental health
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle Chronic mental illness
psychiatric readmission
emergency psychiatry
public mental health
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Morris DW
Ghose S
Williams E
Brown K
Khan F
Evaluating psychiatric readmissions in the emergency department of a large public hospital
description David W Morris,1 Subroto Ghose,1,2 Ella Williams,1,2 Kevin Brown,1,2 Fuad Khan1,2 1Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Department of Psychiatry, Parkland Memorial Hospital, Dallas, TX, USA Introduction: Hospital emergency departments (EDs) around the country are being challenged by an ever-increasing volume of patients seeking psychiatric services. This manuscript describes a study performed to identify internal and external factors contributing to repeated psychiatric patient admissions to the hospital main ED. Methods: Data from ED visits of patients who were admitted to the Parkland Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a psychiatric complaint more than once within a 30-day period were evaluated (n=202). A 50-item readmission survey was used to collect information on demographic and clinical factors associated with 30-day readmission, as well as to identify quality improvement opportunities by assessing related moderating factors. An analysis of acute readmission visits (occurring within 3 days of previous discharge) was also performed. Results: Patients readmitted to the ED commonly present with a combination of acute psychiatric symptoms, substance use (especially in the case of acute readmission), and violent or suicidal behavior. The vast majority of cases reviewed found that readmitted patients had difficulties coordinating care outside the ED. A number of moderating factors were identified and targeted for quality improvement including additional support for filling prescriptions, transportation, communication with family and outside providers, drug and alcohol treatment, intensive case management, and housing. Conclusion: Many of the resources necessary to reduce psychiatric patient visits to hospital EDs are available within the community. There is no formal method of integrating and insuring the continuity of community services that may reduce the demand for psychiatric and related services in the ED. While agreements between community service providers may be challenging and require considerable vigilance to maintain equitable agreements between parties, this route of improving efficiency may be the only available method, given the current and projected patient care needs. Keywords: chronic mental illness, psychiatric readmission, emergency psychiatry, public mental health
format article
author Morris DW
Ghose S
Williams E
Brown K
Khan F
author_facet Morris DW
Ghose S
Williams E
Brown K
Khan F
author_sort Morris DW
title Evaluating psychiatric readmissions in the emergency department of a large public hospital
title_short Evaluating psychiatric readmissions in the emergency department of a large public hospital
title_full Evaluating psychiatric readmissions in the emergency department of a large public hospital
title_fullStr Evaluating psychiatric readmissions in the emergency department of a large public hospital
title_full_unstemmed Evaluating psychiatric readmissions in the emergency department of a large public hospital
title_sort evaluating psychiatric readmissions in the emergency department of a large public hospital
publisher Dove Medical Press
publishDate 2018
url https://doaj.org/article/3ae61b7842d94809a90fe49af0899c9b
work_keys_str_mv AT morrisdw evaluatingpsychiatricreadmissionsintheemergencydepartmentofalargepublichospital
AT ghoses evaluatingpsychiatricreadmissionsintheemergencydepartmentofalargepublichospital
AT williamse evaluatingpsychiatricreadmissionsintheemergencydepartmentofalargepublichospital
AT brownk evaluatingpsychiatricreadmissionsintheemergencydepartmentofalargepublichospital
AT khanf evaluatingpsychiatricreadmissionsintheemergencydepartmentofalargepublichospital
_version_ 1718402095634186240