Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11

In Health Affairs, Jane Zhu and colleagues investigate wait times and discharge outcomes among psychiatric patients in the emergency department (ED). This study is a retrospective comparison of more than 230,000 psychiatric and non-psychiatric visits across 350-400 US EDs between 2002 and 2011. They analyzed length-of-stay (a standard measure of ED crowding and access to services) as well as rates of admissions, discharges, and transfers. Length-of-stay was defined as the difference between the time of triage and time of departure from the ED for a given patient. Patients seen in the ED for psychiatric reasons were more likely to be young, male, uninsured or enrolled in Medicaid, as well as more likely to be admitted for hospitalization than those seen for non-psychiatric reasons. Psychiatric patients were transferred to another facility at six times the rate of nonpsychiatric patients. Median lengths-of-stay were longer for those admitted for observation (355 versus 279 minutes), transferred (312 versus 195 minutes), or discharged (189 versus 144 minutes), but were not different for patients admitted to the hospital. In the context of persistent increases in ED utilization in the 2002-2011 period, gaps in length-of-stay between psychiatric and non-psychiatric patient visits did not close over time. The findings point to some challenges to the ability of EDs to meet the population’s mental health needs, and underlines disparities in access to care for people with mental illnesses. The authors recommend structural and process-related improvements to increase the system’s capacity to care for these patients, such as the use of dedicated psychiatric emergency services and regional psychiatric emergency services