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Authors Morris DW, Ghose S, Williams E, Brown K, Khan F
Received 1 June 2017
Accepted for publication 2 August 2017
Published 1 March 2018 Volume 2018:14 Pages 671—679
DOI https://doi.org/10.2147/NDT.S143004
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Papan Thaipisuttikul
Peer reviewer comments 3
Editor who approved publication: Dr Roger Pinder
Introduction: Hospital emergency departments (EDs) around the country are being
challenged by an ever-increasing volume of patients seeking psychiatric
services. This manuscript describes a study performed to identify internal and
external factors contributing to repeated psychiatric patient admissions to the
hospital main ED.
Methods: Data from ED visits of patients who were admitted to the Parkland
Memorial Hospital ED (the community hospital for Dallas County, TX, USA) with a
psychiatric complaint more than once within a 30-day period were evaluated
(n=202). A 50-item readmission survey was used to collect information on
demographic and clinical factors associated with 30-day readmission, as well as
to identify quality improvement opportunities by assessing related moderating
factors. An analysis of acute readmission visits (occurring within 3 days of
previous discharge) was also performed.
Results: Patients readmitted to the ED commonly present with a combination
of acute psychiatric symptoms, substance use (especially in the case of acute
readmission), and violent or suicidal behavior. The vast majority of cases
reviewed found that readmitted patients had difficulties coordinating care
outside the ED. A number of moderating factors were identified and targeted for
quality improvement including additional support for filling prescriptions,
transportation, communication with family and outside providers, drug and
alcohol treatment, intensive case management, and housing.
Conclusion: Many of the resources necessary to reduce psychiatric patient
visits to hospital EDs are available within the community. There is no formal
method of integrating and insuring the continuity of community services that
may reduce the demand for psychiatric and related services in the ED. While
agreements between community service providers may be challenging and require
considerable vigilance to maintain equitable agreements between parties, this
route of improving efficiency may be the only available method, given the
current and projected patient care needs.
Keywords: chronic mental illness, psychiatric readmission, emergency
psychiatry, public mental health