Abstract
Introduction:We determined if targeted education of emergency physicians (EPs) regarding the treatment of mental illness will improve their comfort level in treating psychiatric patients boarding in the emergency department (ED) awaiting admission.Methods:We performed a pilot study examining whether an educational intervention would change an EP’s comfort level in treating psychiatric boarder patients (PBPs). We identified a set of psychiatric emergencies that typically require admission or treatment beyond the scope of practice of emergency medicine. Diagnoses included major depression, schizophrenia, schizoaffective disorder, bipolar affective disorder, general anxiety disorder, suicidal ideation, and criminal behavior. We designed equivalent surveys to be used before and after an educational intervention. Each survey consisted of 10 scenarios of typical psychiatric patients. EPs were asked to rate their comfort levels in treating the described patients on a visual analogue scale. We calculated summary scores for the non intervention survey group (NINT) and intervention survey group (INT) and compared them using Student’s t-test.Results:Seventy-nine percent (33/42) of eligible participants completed the pre-intervention survey (21 attendings, 12 residents) and comprised the NINT group. Fifty-five percent (23/42) completed the post-intervention survey (16 attendings, 7 residents) comprising the INT group. A comparison of summary scores between ‘NINT’ and ‘INT’ groups showed a highly significant improvement in comfort levels with treating the patients described in the scenarios (P = 0.003). Improvements were noted on separate analysis for faculty (P = 0.039) and for residents (P = 0.012). Results of a sensitivity analysis excluding one highly significant scenario showed decreased, but still important differences between the NINT and INT groups for all participants and for residents, but not for faculty (all: P = 0.05; faculty: P = 0.25; residents: P = 0.03).Conclusion:This pilot study suggests that the comfort level of EPs, when asked to treat PBPs, may be improved with education. We believe our data support further study of this idea and of whether an improved comfort level will translate to a willingness to treat.
Highlights
IntroductionA survey conducted at the University of Utah emergency department (ED) showed that psychiatric patients were more likely to be readmitted than medical patients within 30 days (21% versus 13.4%).[5] There was a 21.1% increase in state mental health admissions between 2002 and 2005 in 8 key states in the United States.[4] A recent study from California revealed a mental health system in crisis where increasing demand for inpatient psychiatric beds is being met with a diminishing supply
We determined if targeted education of emergency physicians (EPs) regarding the treatment of mental illness will improve their comfort level in treating psychiatric patients boarding in the emergency department (ED) awaiting admission
Further studies are needed to corroborate our findings in a larger more varied setting. This pilot study suggests that it may be possible to improve the comfort level of EPs when asked to treat psychiatric patients, such as those described in our scenarios, by using a focused educational tool
Summary
A survey conducted at the University of Utah ED showed that psychiatric patients were more likely to be readmitted than medical patients within 30 days (21% versus 13.4%).[5] There was a 21.1% increase in state mental health admissions between 2002 and 2005 in 8 key states in the United States.[4] A recent study from California revealed a mental health system in crisis where increasing demand for inpatient psychiatric beds is being met with a diminishing supply This has resulted in wait times for adult psychiatric patients exceeding 16 hours.[11] These phenomena may have been augmented by recidivism, emphasizing the urgency of finding a solution for this expanding problem
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