The use of a psychiatric overflow unit in a large urban community hospital to improve process outcomes

JEM reports Pub Date : 2024-03-09 DOI:10.1016/j.jemrpt.2024.100083

Bahareh Aslani-Amoli , Alex Marwaha , Maria Stepanova , Sarah Rhine , Samir Nader , Linda Henry , John Howell , Tanveer Gaibi

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Abstract

Background

The United States is experiencing a mental health (MH) crisis with limited resources to meet demands. We established a 5-bed psychiatric overflow unit (POU) within the emergency department (ED) as a care alternative.

Objective

Determine the clinical utility and safety of a POU in care delivery to patients in a MH crisis compared to the main ED (controls).

Methods

Retrospective study using data from electronic health record/chart review [October 1, 2021–May 31, 2022 (POU established January 2022)] for all ED patients ≥12 years admitted with MH crisis. Per triage nurse, patients for potential hospital admission were POU admitted when medically cleared. Clinical utility definition: ED length of stay (LOS); patient safety definition: return to ED within 72 h for same complaint.

Results

Patients (n = 919; POU = 302, main ED = 617) were 61.4% male, mean age 39.7 ± 15.6 years, 84.2% ESI 2, 61.7% admitted/transferred, average ED LOS was 932.3 ± 804.7 min and no returns within 72 h. POU had longer ED LOS (1058.7 ± 736.5 vs 884.6 ± 824.6, P < 0.0001) but no differences among admitted/transferred patients comparing POU vs controls (P > 0.05); Among discharged patients POU compared to main ED had a longer mean ED LOS (819.9 ± 779.8 vs 486.4 ± 577.3, P < 0.0001); Removal of police escort patients did not change POU ED LOS (P < 0.05).

Conclusions

An ED POU, staffed with behavioral health nurses, had equivocal safety and clinical utility as the main ED potentially providing an alternative care-delivery option when ED space and MH resources are limited.

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一家大型城市社区医院利用精神科分流病房改善流程成果

背景美国正在经历一场心理健康（MH）危机，但资源有限，难以满足需求。我们在急诊科（ED）内设立了一个拥有 5 张床位的精神科分流病房（POU），作为一种护理替代方案。研究方法：使用电子健康记录/病历回顾[2021 年 10 月 1 日至 2022 年 5 月 31 日（POU 于 2022 年 1 月设立）]中的数据，对所有因精神健康危机入院的年龄≥12 岁的急诊科患者进行回顾性研究。根据分诊护士提供的信息，可能入院的患者在医疗条件允许的情况下被 POU 收治。临床效用定义：结果患者（n = 919；POU = 302，主ED = 617）中61.4%为男性，平均年龄为（39.7 ± 15.6）岁，84.2%为ESI 2，61.7%为入院/转院，平均ED LOS为（932.3 ± 804.7）分钟，72小时内无复诊。POU 的 ED LOS 更长（1058.7 ± 736.5 vs 884.6 ± 824.6，P < 0.0001），但在入院/转院患者中，POU 与对照组相比无差异（P > 0.05）；在出院患者中，与主 ED 相比，POU 的平均 ED LOS 更长（819.9 ± 779.8 vs 486.4 ± 577.结论：配备行为健康护士的急诊室 POU 在安全性和临床实用性方面与主急诊室不相上下，有可能在急诊室空间和 MH 资源有限的情况下提供另一种护理服务选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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