Abstract
Objective. This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS). Methods. We examined data from 580 ED mental health visits made to two urban EDs by children aged ≤18 years from April 1, 2004, to March 31, 2006. Logistic regressions identified characteristics associated with wait time and LOS using hazard ratios (HR) with 95% confidence intervals (CIs). Results. Sex (male: HR = 1.48, 95% CI = 1.20–1.84), ED type (pediatric ED: HR = 5.91, 95% CI = 4.16–8.39), and triage level (Canadian Triage and Acuity Scale (CTAS) 2: HR = 3.62, 95% CI = 2.24–5.85) were statistically significant predictors of wait time. ED type (pediatric ED: HR = 1.71, 95% CI = 1.18–2.46), triage level (CTAS 5: HR = 2.00, 95% CI = 1.15–3.48), number of consultations (HR = 0.46, 95% CI = 0.31–0.69), and number of laboratory investigations (HR = 0.75, 95% CI = 0.66–0.85) predicted LOS. Conclusions. Based on our results, quality improvement initiatives to reduce ED waits and LOS for pediatric mental health visits may consider monitoring triage processes and the availability, access, and/or time to receipt of specialty consultations.
Highlights
In recent years, there has been considerable documentation of increases in visits by children to the emergency department (ED) for crisis mental health care [1,2,3,4,5,6,7,8,9]
This study explores the association of patient and emergency department (ED) mental health visit characteristics with wait time and length of stay (LOS)
Longer ED wait times for patients of all ages have been associated with a higher triage level, an increased patient census (ED occupancy), urban-based EDs, Emergency Medicine International day of arrival (Sunday, Monday, or Wednesday), and arrival by “walk-in” [26,27,28,29,30,31]
Summary
Intentional self-injury, age 6–13 years, use of laboratory testing, hospital location, and patient transfer have been associated with extended ED stays for pediatric mental health visits [17], while limited staff availability for psychiatric assessments, clinical instability, and limited bed availability have been associated with longer ED LOS for adult mental health visits [37]. This body of literature raises important questions for pediatric emergency mental health care including how to ensure treatment timeliness and quality of care.
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