Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry
Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aime...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-06-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1010-660X/56/6/295 |
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| author | Alessandra Costanza Viridiana Mazzola Michalina Radomska Andrea Amerio Andrea Aguglia Paco Prada Guido Bondolfi François Sarasin Julia Wahener Ambrosetti |
| author_facet | Alessandra Costanza Viridiana Mazzola Michalina Radomska Andrea Amerio Andrea Aguglia Paco Prada Guido Bondolfi François Sarasin Julia Wahener Ambrosetti |
| author_sort | Alessandra Costanza |
| collection | DOAJ |
| description | Background and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (<i>n</i> = 763 total admissions for psychiatric conditions; <i>n</i> = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST<sup>®</sup>) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED. |
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| institution | Directory Open Access Journal |
| issn | 1010-660X |
| language | English |
| last_indexed | 2024-03-12T06:12:38Z |
| publishDate | 2020-06-01 |
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| spelling | doaj.art-4c513ecba00e4dcab301aed1e6b8792a2023-09-03T02:51:27ZengMDPI AGMedicina1010-660X2020-06-015629529510.3390/medicina56060295Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for TelepsychiatryAlessandra Costanza0Viridiana Mazzola1Michalina Radomska2Andrea Amerio3Andrea Aguglia4Paco Prada5Guido Bondolfi6François Sarasin7Julia Wahener Ambrosetti8Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, SwitzerlandDepartment of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals (HUG), 1211 Geneva, SwitzerlandFaculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, SwitzerlandDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, ItalyDepartment of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, SwitzerlandDepartment of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, SwitzerlandDepartment of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, SwitzerlandDepartment of Psychiatry and Emergency Department, Emergency Psychiatric Unit, Geneva University Hospitals, 1211 Geneva, SwitzerlandBackground and Objectives: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Materials and Methods: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. Results: In our sample (<i>n</i> = 763 total admissions for psychiatric conditions; <i>n</i> = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients’ trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST<sup>®</sup>) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Conclusions: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.https://www.mdpi.com/1010-660X/56/6/295psychiatric emergencysuicidal behaviordepressionpsychotic episodesubstance use disordertelepsychiatry |
| spellingShingle | Alessandra Costanza Viridiana Mazzola Michalina Radomska Andrea Amerio Andrea Aguglia Paco Prada Guido Bondolfi François Sarasin Julia Wahener Ambrosetti Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry Medicina psychiatric emergency suicidal behavior depression psychotic episode substance use disorder telepsychiatry |
| title | Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry |
| title_full | Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry |
| title_fullStr | Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry |
| title_full_unstemmed | Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry |
| title_short | Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry |
| title_sort | who consult an adult psychiatric emergency department pertinence of admissions and opportunities for telepsychiatry |
| topic | psychiatric emergency suicidal behavior depression psychotic episode substance use disorder telepsychiatry |
| url | https://www.mdpi.com/1010-660X/56/6/295 |
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