Hours and Miles: Patient and Health System Implications of Transfer for Psychiatric Bed Capacity
Introduction: An increasing number of behavioral health (BH) patients are presenting to the emergency department (ED) while BH resources continue to decline. This situation may lead to more external transfers to find care. Methods: This is a retrospective cohort study of consecutive patients pres...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
eScholarship Publishing, University of California
2016-11-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/8s75v7xj |
| Summary: | Introduction: An increasing number of behavioral health (BH) patients are presenting to the
emergency department (ED) while BH resources continue to decline. This situation may lead to more
external transfers to find care.
Methods: This is a retrospective cohort study of consecutive patients presenting to a tertiary
care academic ED from February 1, 2013, through January 31, 2014. Patients were identified
through electronic health record documentation of psychiatric consultation during ED evaluation.
We reviewed electronic health records for demographic characteristics, diagnoses, payer source,
ED length of stay, ED disposition, arrival method, and distance traveled to an external facility for
inpatient admission. Univariable and multivariable associations with transfer to an external facility
in comparison with patients admitted internally were evaluated with logistic regression models and
summarized with odds ratios (OR).
Results: We identified 2,585 BH visits, of which 1,083 (41.9%) resulted in discharge. A total of 1,502
patient visits required inpatient psychiatric admission, and of these cases, 177 patients (11.8%; 95%
CI = [10.2-13.5]) required transfer to an external facility. The median ED length of stay for transferred
patients was 13.9 hours (interquartile range [IQR], 9.3-20.2 hours; range, 3.0-243.0 hours). The
median distance for transport was 83 miles (IQR, 42-111 miles; range, 42-237 miles). In multivariable
analysis, patients with suicidal or homicidal ideation had increased risk of transfer (odds ratio [OR]
[95% CI], 1.93 [1.22-3.06]; P=0.005). Children younger than 18 years (OR [95% CI], 2.34 [1.60-
3.40]; P<0.001) and adults older than 65 years (OR [95% CI], 3.46 [1.93-6.19]; P<0.001) were more
likely to require transfer and travel farther to access care.
Conclusion: Patients requiring external transfer for inpatient psychiatric care were found to have
prolonged ED lengths of stay. Patients with suicidal and homicidal ideation as well as children and
adults older than 65 years are more likely to require transfer. |
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| ISSN: | 1936-900X 1936-9018 |