A Narrative Review of Predictors of Adult Mental Health Emergency Department Return Visits and Interventions to Reduce Repeated Use.

Abstract

Frequent utilizers of the emergency department (ED) are a minority of patients that account for a majority of visits to psychiatric emergency services and general EDs. The primary aim of this narrative review is to synthesize the literature by describing patient characteristics correlated with adult mental health ED revisits and the efficacy of interventions for reducing frequent use. A review of the literature was performed following a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol checklist in PubMed, PsycINFO, and Google Scholar databases. Thirty-one articles, mostly retrospective cohort studies, met inclusion criteria. The most commonly studied sociodemographic and clinical characteristics associated with frequent users were age, homelessness, diagnosis of schizophrenia or a substance use/abuse disorder, and receipt of current psychiatric treatment. There were 7 different categories of interventions that were studied; only 2 demonstrated a significant reduction in revisits. Based on the current literature, high utilization of emergency mental health care is most strongly associated with financial and economic factors. These frequent users are also typically characterized as having substance use/abuse disorders, a diagnosis of schizophrenia, and current psychiatric treatment. Though most interventions have been unsuccessful in mitigating revisits, certain ED-based interventions that modified patient care based on the acute clinical needs demonstrated a significant reduction in repeated use. Further interventions should involve modifications to care at the level of the hospital, as well as the community and follow-up care.