Misek Ryan K, Magda Ashley D, Margaritis Samantha, Long Robert, Frost Erik
Midwestern University, Chicago College of Osteopathic Medicine, Downers Grove, Illinois.
J Emerg Med. 2017 Jul;53(1):85-90. doi: 10.1016/j.jemermed.2017.03.032. Epub 2017 May 13.
Psychiatric patient boarding in the emergency department (ED) is a ubiquitous problem associated with increased morbidity and mortality.
We evaluate the effect of closing a public psychiatric facility in a major metropolitan area on the ED length of stay (LOS) of psychiatric patients.
This was a retrospective chart review at two metropolitan EDs of all patients assessed to require inpatient psychiatric hospitalization. The time of arrival, time of disposition, time of transfer, insurance status, and accepting facility type were collected prior to and following the closure of a local inpatient psychiatric facility.
We analyzed a total of 1107 patients requiring inpatient psychiatric hospitalization, with 671 patients who presented prior to the closure of the closest public psychiatric facility and 436 patients that presented following the facility closure. Following hospital closure, patients with private insurance (620 min before, 771 min after) and Medicare/Medicaid (642 min before, 718 min after) had statistically significantly longer ED LOS, as well as patients transferred to a private psychiatric hospital (664 min prior, 745 min after). However, overall ED length of stay following hospital closure for transfer of all psychiatric patients requiring inpatient hospitalization was not found to be statistically significant (1017 min prior, 967 min after).
There was a statistically significant increase in ED LOS for patients with private insurance, Medicare/Medicaid, and for those patients transferred to a private psychiatric facility following closure of a public mental health hospital; however, overall, ED LOS was not increased for patients transferred to an inpatient psychiatric facility. This study highlights the significant impact that the closure of a single inpatient psychiatric facility can have on nearby EDs. We hope to bring attention to the need for increased psychiatric services during a time when there is a nationwide trend toward the reduction of available inpatient psychiatric beds.
急诊科收治精神科患者是一个普遍存在的问题，与发病率和死亡率增加相关。
我们评估在一个主要大都市地区关闭一家公立精神科机构对精神科患者急诊科住院时间（LOS）的影响。
这是一项对两家大都市急诊科所有被评估需要住院精神科治疗的患者进行的回顾性病历审查。在当地一家住院精神科机构关闭之前和之后，收集了患者的到达时间、处置时间、转院时间、保险状况和接收机构类型。
我们共分析了1107例需要住院精神科治疗的患者，其中671例在最近的公立精神科机构关闭之前就诊，436例在机构关闭之后就诊。医院关闭后，拥有私人保险的患者（之前620分钟，之后771分钟）和医疗保险/医疗补助患者（之前642分钟，之后718分钟）的急诊科住院时间在统计学上显著延长，转至私立精神科医院的患者也是如此（之前664分钟，之后745分钟）。然而，在医院关闭后，所有需要住院治疗的精神科患者转院后的总体急诊科住院时间在统计学上没有显著差异（之前1017分钟，之后967分钟）。
在一家公立精神科医院关闭后，拥有私人保险、医疗保险/医疗补助的患者以及转至私立精神科机构的患者的急诊科住院时间在统计学上有显著增加；然而，总体而言，转至住院精神科机构的患者的急诊科住院时间并未增加。本研究强调了关闭一家住院精神科机构对附近急诊科可能产生的重大影响。我们希望在全国范围内出现住院精神科病床减少趋势的时期，引起人们对增加精神科服务需求的关注。
