Department of Pediatrics, BC Children's Hospital, University of British Columbia, B428B- 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
British Columbia Children's Hospital Research Institute, Vancouver, Canada.
CJEM. 2021 Jan;23(1):103-110. doi: 10.1007/s43678-020-00005-7. Epub 2020 Dec 10.
Variability in expertise and risk tolerance among emergency departments (ED) clinicians, when assessing and managing pediatric mental health presentations, leads to increased resource utilization. HEARTSMAP is a validated electronic tool that supports ED clinicians in psychosocial assessments and disposition decision making.
We used interrupted time series analysis (September 2016-December 2019) and multivariable regressions to measure the impact of integrating HEARTSMAP into ED practice on pediatric mental health presentations length of stay and return visits, at two pediatric EDs. The intervention site used HEARTSMAP trained ED clinicians to assess and manage mental health presentations, and reported bi-weekly ED median length of stay and 30 days-return visits for 15 months and a year, during passive and active implementation of HEARTSMAP, respectively. The control site used psychiatric nurses to assess and manage patients and was only exposed to passive implementation.
HEARTSMAP average uptake was on average 47.4% (range 23.8-74.6%) during active implementation at the intervention site, while the control site showed no uptake throughout the study period. Incremental HEARSTMAP (each percent increase) use was associated with a reduction of 1.8 min (95% CI 0.8-2.9 in ED length of stay and 0.3% (95% CI 0.2-0.5 in 30-day return visit rate. This translates to an adjusted average reduction of 85.3 min in ED length of stay and 15.2% in 30-day return visits for youth with mental health presentations.
Use of HEARTSMAP in the ED can decrease length of stay and return visits for emergency pediatric mental health visits, in a fixed-resource setting.
急诊科（ED）临床医生在评估和管理儿科心理健康表现时，专业知识和风险承受能力存在差异，这导致资源利用增加。HEARTSMAP 是一种经过验证的电子工具，可支持 ED 临床医生进行心理社会评估和处置决策。
我们使用中断时间序列分析（2016 年 9 月至 2019 年 12 月）和多变量回归来衡量将 HEARTSMAP 整合到 ED 实践中对儿科心理健康表现的停留时间和复诊的影响，在两个儿科 ED 进行。干预地点使用经过 HEARTSMAP 培训的 ED 临床医生评估和管理心理健康表现，并在被动和主动实施 HEARTSMAP 期间，分别报告 15 个月和一年的 ED 中位数停留时间和 30 天复诊。对照地点使用精神科护士评估和管理患者，并且仅在被动实施期间暴露。
在干预地点主动实施期间，HEARTSMAP 的平均使用率平均为 47.4%（范围为 23.8-74.6%），而对照地点在整个研究期间均未使用。HEARSTMAP 的增量（每增加 1%）使用与 ED 停留时间减少 1.8 分钟（95%CI 0.8-2.9）和 30 天复诊率降低 0.3%（95%CI 0.2-0.5）相关。这相当于调整后 ED 停留时间减少 85.3 分钟，30 天复诊率降低 15.2%，心理健康表现的青少年就诊。
在固定资源环境中，ED 中使用 HEARTSMAP 可以减少急诊儿科心理健康就诊的停留时间和复诊。
