Emergency Department Wait Times for Geriatric Psychiatric Patients.

Abstract

Older adults with complicated illnesses such as Alzheimer's disease often require specialized treatment in geriatric facilities when inpatient psychiatric hospitalization is needed. However, there is a shortage of these inpatient facilities. Thus, patients could wait in the emergency department (ED) for days pending availability of a bed at an appropriate facility. The objective of this study was to quantify that wait time. Records for patients aged 60-89 years who were seen in the ED and had a psychiatric consultation over a 2-year period (July 2014 to June 2016) were reviewed. Total mean time spent in the ED was calculated on the basis of check-in time and time discharged from the ED. We also attempted to calculate the mean wait time for psychiatric consultation and wait time to disposition; however, for many visits, there was no record of when the consultation request was placed and when the recommendations were relayed back to the ED physician. Mean age at time of visit was 66.67 years. Diagnosis of dementia or a neurocognitive disorder most commonly led to referral to geriatric psychiatry rather than other psychiatric services. Of the visits, the most common disposition recommendation was for discharge with outpatient follow-up, and the least common recommendation was admission to the medical unit. The mean time in the ED was over a day for patients with a recommendation for admission and only 13 hours for patients with a recommendation for discharge. Overall, the findings of this study reiterate the need for more intensive research and improvements in the assessment and care of older adults with psychiatric needs in the ED setting.