Abstract
BackgroundHospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. We endeavoured to understand clinician-related factors that influence the decision to admit.MethodsWe retrospectively examined data collected between August 1, 2013 and July 31, 2015 for patients triaged as mental health assessments in the emergency department of a university teaching hospital. We identified 1530 unique cases who had been reviewed by the staff psychiatrist for a decision on whether to admit to an acute care bed. Patient and physician characteristics were analyzed by standard descriptive methods, comparative statistics (Chi square and analysis of variance) and regression analyses using SPSS version 24.0 (IBM Corp. Armonk, NY, USA).ResultsThere were no differences in patient characteristics in the clinical encounters reviewed by different staff psychiatrists. The physician factor found significant in deciding whether to admit the patient was assignment to PES (psychiatric emergency services). This appeared to be the only physician variable impacting the decision to admit a patient with PES psychiatrists admitting less often than their colleagues (p = 0.018, Table 3). The effect size of the variable in terms of odds ratio was 0.592.InterpretationTraining and practice in emergency psychiatry lead to lower admission rates when these clinicians are on call. Training in emergency psychiatry for all psychiatrists participating in a call pool may result in lowered admission rates.
Highlights
Hospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed
31 physicians saw these encounters with a mean of 49.4 encounters per physician
Previous studies have focused on patient and systems factors that influence the decision to admit a patient seen in the emergency department to the psychiatry inpatient unit [8]
Summary
Hospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. The decision to admit a patient from a teaching hospital emergency department is generally at the discretion of the consultant specialist following a referral from the emergency room (ER) physician. The patient is usually first assessed by the specialty resident on call before reviewing the patient with the specialty consultant on call This arrangement is fairly standard across North American teaching hospitals with some variation at different locations. Previous studies looking at admissions to psychiatry have examined patient factors that tend to predict admission. These factors include, but are not limited to, elevated suicide risk, specific diagnosis (schizophrenia and affective disorders) and a history of poor impulse control reflected in suicide attempts, self-harm behaviours, and substance abuse [1, 2]. There have been efforts to study the decision-making process that determines whether a patient is admitted to psychiatry
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