Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts).
Psychiatr Serv. 2019 Nov 1;70(11):1053-1056. doi: 10.1176/appi.ps.201900112. Epub 2019 Jul 30.
This study examined recent growth in demand for acute mental health and addiction (MHA) care in a large urban center and changes in patient flow following the expansion of a psychiatric emergency department (ED).
A retrospective observational design used administrative data in adjusted negative binomial regression models to identify time trends at seven hospitals over a 6-year period in central Toronto. Two-part linear spline models compared trends before and after a psychiatric ED expansion.
Per capita MHA-related ED visits grew rapidly across the acute care system over the study period, although admissions per MHA ED visit decreased. Expanding a psychiatric ED did not influence overall system-level growth, but it significantly shifted traffic; the annual MHA ED visit growth rate increased at the expanded ED while decreasing at surrounding hospitals.
Given increasing demand systemwide, individual hospital ED expansions may be inappropriate; planning should consider the whole system.
本研究调查了在一个大型城市中心，急性心理健康和成瘾（MHA）护理需求的近期增长情况，以及在扩大精神科急诊部（ED）后患者流量的变化。
采用回顾性观察设计，使用行政数据，在调整后的负二项式回归模型中，确定了多伦多市中心 7 家医院在 6 年期间的时间趋势。两部分线性样条模型比较了 ED 扩张前后的趋势。
在研究期间，急性护理系统中与 MHA 相关的 ED 就诊人数迅速增长，尽管每次 MHA ED 就诊的入院人数有所下降。扩大精神科 ED 并没有影响整个系统层面的增长，但它显著改变了流量；在扩大的 ED 中，MHA ED 就诊的年增长率增加，而周边医院的增长率则下降。
鉴于整个系统需求的增加，单个医院 ED 的扩张可能不合适；规划应考虑整个系统。
