Behavioral Health Resource Utilization of Emergency Department Patients Presenting from Mass Gathering Events

Abstract

Introduction:Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.Aim:To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.Methods:Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.Results:209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.Discussion:Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.