186: Trends in Emergency Department Utilization By Children with Mental Health Issues

Abstract

Pediatric mental health emergencies constitute a significant and growing proportion of overall visits to pediatric emergency departments (PEDs), as demonstrated by American studies. However, there is little published data on the utilization of PEDs by patients with mental health issues in Canada. To describe the trends in utilization of PED resources by mental health patients over the last 10 years at the British Columbia Children's Hospital (BCCH). We primarily reported the number and acuity of mental health related visits, their length of stay (LOS), admission rate and return visits, relative to all PED visits. We conducted a retrospective cohort study of PED visits at BCCH from 2003 to 2012. All visits with chief complaints or discharge diagnosis including terms related to mental health disorders were selected for evaluation. Descriptive statistics were used to summarize our findings. We observed a 38% increase in the number of pediatric mental health presentations compared to a 9% increase in the number of total visits to the PED over the study period. Repeat visits represented a significant proportion of all mental health related visits to the ED. Yearly, 31% to 36% of all mental health related visits were repeated visits, a third of those occurring within 30 days from the index visit. Moreover, while the proportion of visits for mental health concerns triaged to a high acuity level has steadily decreased, the proportion of visits triaged to the mid-acuity level has steadily increased. Mean LOS in the ED for mental health patients increased from 295 min in 2003 to 318 min in 2012. These LOS are significantly longer then for overall visits to the ED (171 min in 2003; 234 min in 2012). We also observed that the number of PED visits for a psychiatric concern resulting in an admission has increased by 50% between 2003 and 2012. Mental health related visits represent a significant and growing burden for the ED at a tertiary care PED. The largest proportion of psychiatric related visits are now triaged to mid-level acuity, possibly reflecting a shortage of community mental health services. These results highlight the need to reassess health resource allocation to ensure optimal care for children affected by mental health illnesses and to consider alternative ways to optimize risk assessment as well as improving the linkage to mental health services upon disposition from the PED.