Creed Jamie O, Cyr Julianne M, Owino Hillary, Box Shannen E, Ives-Rublee Mia, Sheitman Brian B, Steiner Beat D, Williams Jefferson G, Bachman Michael W, Cabanas Jose G, Myers J Brent, Glickman Seth W
Prehosp Emerg Care. 2018 Sep-Oct;22(5):555-564. doi: 10.1080/10903127.2018.1428840. Epub 2018 Feb 7.
Emergency Departments (ED) are overburdened with patients experiencing acute mental health crises. Pre-hospital transport by Emergency Medical Services (EMS) to community mental health and substance abuse treatment facilities could reduce ED utilization and costs. Our objective was to describe characteristics, treatment, and outcomes of acute mental health crises patients who were transported by EMS to an acute crisis unit at WakeBrook, a North Carolina community mental health center.
We performed a retrospective cohort study of patients diverted to WakeBrook by EMS from August 2013-July 2014. We abstracted data from WakeBrook medical records and used descriptive statistics to quantify patient characteristics, diagnoses, length of stay (LOS), and 30-day recidivism.
A total of 226 EMS patients were triaged at WakeBrook. The median age was 38 years, 55% were male, 58% were white, and 38% were uninsured. The most common chief complaints were suicidal ideation or self-harm (46%) and substance abuse (19%). The most common diagnoses were substance-related and addictive disorders (42%), depressive disorders (32%), and schizophrenia spectrum and other psychotic disorders (22%). Following initial evaluation, 28% of patients were admitted to facilities within WakeBrook, 40% were admitted to external psychiatric facilities, 18% were stabilized and discharged home, 5% were transferred to an ED within 4 hours for further medical evaluation, and 5% refused services. The median LOS at WakeBrook prior to disposition was 12.0 hours (IQR 5.4-21.6). Over a 30-day follow-up period, 60 patients (27%) had a return visit to the ED or WakeBrook for a mental health issue.
A dedicated community mental health center is able to treat patients experiencing acute mental health crises. LOS times were significantly shorter compared to regional EDs. Successful broader programmatic implementation could improve care quality and significantly reduce the volume of patients treated in the ED for acute mental health disorders.
急诊科（ED）因应对急性心理健康危机的患者而不堪重负。紧急医疗服务（EMS）将患者院前转运至社区心理健康和药物滥用治疗机构可减少急诊科的使用及成本。我们的目的是描述由EMS转运至北卡罗来纳州社区心理健康中心韦克布鲁克的急性危机单元的急性心理健康危机患者的特征、治疗及结局。
我们对2013年8月至2014年7月间由EMS转运至韦克布鲁克的患者进行了一项回顾性队列研究。我们从韦克布鲁克的医疗记录中提取数据，并使用描述性统计来量化患者特征、诊断、住院时间（LOS）及30天再入院率。
共有226名由EMS转运的患者在韦克布鲁克接受了分诊。中位年龄为38岁，55%为男性，58%为白人，38%未参保。最常见的主诉是自杀观念或自伤（46%）和药物滥用（19%）。最常见的诊断是物质相关及成瘾性障碍（42%）、抑郁障碍（32%）以及精神分裂症谱系和其他精神病性障碍（22%）。初始评估后，28%的患者被收治入韦克布鲁克内的机构，40%被收治入外部精神病机构，18%病情稳定后出院回家，5%在4小时内被转至急诊科进行进一步医学评估，5%拒绝接受服务。处置前在韦克布鲁克的中位住院时间为12.0小时（四分位间距5.4 - 21.6）。在30天的随访期内，60名患者（27%）因心理健康问题再次就诊于急诊科或韦克布鲁克。
一家专门的社区心理健康中心能够治疗经历急性心理健康危机的患者。与地区急诊科相比，住院时间显著更短。成功更广泛地实施该项目可改善护理质量并显著减少急诊科治疗的急性心理健康障碍患者数量。
