Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
Am J Emerg Med. 2020 Dec;38(12):2536-2544. doi: 10.1016/j.ajem.2019.12.035. Epub 2019 Dec 20.
Examine trends in mental health-related emergency department (ED) visits, changes in disposition and length of stay (LOS), describe disposition by age and estimate proportion of ED treatment hours dedicated to mental health-related visits.
Retrospective analysis of ED encounters in the National Hospital Ambulatory Medical Care Visit Survey with a mental health primary, secondary or tertiary discharge diagnosis from 2009 to 2015. We report survey-weighted estimates of the number and proportion of ED visits that were mental health-related and disposition by age and survey year. We estimate the proportion of ED treatment hours dedicated to mental health-related visits. We analyze trends in disposition and LOS for mental health and non-mental health-related visits using multivariate regression analysis.
Mental health-related ED visits increased by 56.4% for pediatric patients and 40.8% for adults, accounting for over 10% of ED visits by 15-64 year-olds and nearly 9% by 10-14 year-olds in 2015. Mental health-related visit disposition of admission or transfer declined from 29.8% to 20.4% (p < .001); predicted median ED LOS for admissions or transfers increased from 6.5 to 9.0 hours while median LOS for discharges was stable at 4.4 hours. During the study period, mental health-related visits accounted for 5.0% (95% CI 4.6-5.3) of all pediatric and 11.1% (95% CI 11.0-11.3) of adult ED treatment hours.
Mental health-related visits account for an increasing proportion of ED visits and a considerable proportion of treatment hours. A decreasing proportion of mental health-related visits resulted in inpatient disposition and ED LOS increased for admissions and transfers.
考察心理健康相关急诊就诊量的变化趋势、处置方式和住院时间（LOS）的变化，按年龄描述处置方式，并估计用于心理健康相关就诊的急诊治疗时间比例。
对 2009 年至 2015 年期间国家医院门诊医疗就诊调查中具有心理健康主要、次要或三级出院诊断的急诊就诊进行回顾性分析。我们报告了经过调查加权的急诊就诊中与心理健康相关的就诊数量和比例以及按年龄和调查年份的处置方式。我们估计了用于心理健康相关就诊的急诊治疗时间比例。我们使用多变量回归分析分析了心理健康和非心理健康相关就诊的处置和 LOS 的趋势。
儿科患者的心理健康相关急诊就诊量增加了 56.4%，成人患者增加了 40.8%，在 2015 年，15-64 岁患者中有超过 10%的就诊和 10-14 岁患者中有近 9%的就诊与心理健康相关。心理健康相关就诊的入院或转科处置率从 29.8%下降到 20.4%（p<0.001）；预计入院或转科的急诊 LOS 中位数从 6.5 小时增加到 9.0 小时，而出院的 LOS 中位数保持在 4.4 小时。在研究期间，心理健康相关就诊占儿科所有就诊的 5.0%（95%置信区间 4.6-5.3）和成人就诊的 11.1%（95%置信区间 11.0-11.3）。
心理健康相关就诊占急诊就诊量的比例不断增加，占治疗时间的比例也相当大。心理健康相关就诊的比例下降导致入院处置减少，入院和转科的急诊 LOS 增加。
