2023 14th Annual NUBE Conference

Background: Limited access to mental health resources, particularly inpatient beds, can lead to prolonged time awaiting psychiatric hospitalization in emergency departments (ED). There is limited research exploring factors that influence this prolonged wait time for psychiatric patients. Our study aimed to investigate sociodemographic and clinical variables associated with the time spent awaiting psychiatric admission for patients in the ED at a large academic tertiary care center. Methods: We conducted a retrospective chart review focusing on adults admitted to an acute inpatient psychiatric unit through an academic tertiary care center ED over the span of one year. Sociodemographic data including age, sex, marital status, race, and insurance type, were collected. Clinical variables, such as primary diagnosis, current suicide attempt, current self-injurious behaviors, history of a suicide attempt, history of psychiatric hospitalization, involuntary status, use of acute intramuscular injections, and use of physical restraints, were also extracted. Temporal factors such as timing of presentation within the day of the week and the season of the calendar year were also included. Multiple regression modeling was employed to identify factors associated with prolonged time awaiting psychiatric admission in the ED. Results: A total of 498 patients were included in the study (mean age: 34.3±11.1) with a female-to-male ratio of 0.83. 77 % were Caucasian and 16 % were African American. The mean time awaiting psychiatric admission in the ED was 29.6±25.1 hours. Visits during fall months (September, October, and November) (p = 0.004), weekends (p = 0.001), involuntary status (p< 0.001), and use of acute intramuscular injections (p< 0.001) were significantly associated with a prolonged time awaiting admission in the ED. Primary psychiatric diagnosis of major depressive disorder (p = 0.024) was associated with a shorter time awaiting psychiatric admission in the ED. Current self-injurious behaviors (p = 0.050) and African American race (p = 0.096) showed a non-significant trend towards longer stays. Conclusions: The use of acute intramuscular injections was the most significant factor associated with longer time awaiting psychiatric hospitalization in the ED, followed by involuntary status, and ED visit during the weekend or fall season. A diagnosis of major depressive disorder was associated with shorter time awaiting psychiatric admission in the ED. Recognizing these factors and implementing strategies to address barriers to admission (e.g. staff verbal de-escalation training, acute intramuscular injections stewardship considerations, increasing inpatient staffing to accommodate for high acuity patients, etc.) may play a role in addressing the multifactorial issue of prolonged time awaiting psychiatric hospitalization in the ED.

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Race and Involuntary Psychiatric Admission Among Veterans: A Retrospective Chart Review Sahana Malik