Psychiatric referrals to the general hospital emergency department: are we being effective?
IntroductionGeneral hospital emergency departments (GHEDs) are notoriously overcrowded. This is caused, in part, by ineffective referrals, that is to say referrals that do not require medical examination or other interventions in the context of a general hospital. This study aims to investigate the...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-08-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1166191/full |
| _version_ | 1797756990770905088 |
|---|---|
| author | Shikma Keller Einat Tilbor Afnan Shwiki Sharon Florentin Sofia Laufer Omer Bonne Laura Canetti Laura Canetti Inbal Reuveni |
| author_facet | Shikma Keller Einat Tilbor Afnan Shwiki Sharon Florentin Sofia Laufer Omer Bonne Laura Canetti Laura Canetti Inbal Reuveni |
| author_sort | Shikma Keller |
| collection | DOAJ |
| description | IntroductionGeneral hospital emergency departments (GHEDs) are notoriously overcrowded. This is caused, in part, by ineffective referrals, that is to say referrals that do not require medical examination or other interventions in the context of a general hospital. This study aims to investigate the contribution of psychiatric referrals to this issue, to identify potential determinants of these referrals and offer means to reduce them.Materials and methodsRetrospective data were collected from psychiatric admission files within a GHED of a tertiary-care city hospital over a 1 year period. Two experienced clinicians separately reviewed each file to determine rationale of referrals according to predetermined criteria.ResultsA total of 2,136 visits included a psychiatric examination, 900 (42.1%) were determined “effective,” and 1,227 (57.4%) were deemed “potentially ineffective.” The leading causes for potentially ineffective referrals to a GHED were psychiatric illness exacerbation (43.4%), and suicidal ideations (22%). Most referrals (66.9%) were initiated by the patient or their family, and not by a primary care physician or psychiatrist.ConclusionMore than half of the psychiatric referrals did not necessarily require the services of a general hospital, and may be more suitable for referral to a dedicated psychiatric facility. Ineffective referrals to the GHED pose a burden on general hospital resources, and may be less effective for the psychiatric patients. This calls for clear guidelines for the provision of optimal emergency treatment for mental-health patients. |
| first_indexed | 2024-03-12T18:09:33Z |
| format | Article |
| id | doaj.art-9e95c4d52dba40a9a74616c0fd91033c |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-03-12T18:09:33Z |
| publishDate | 2023-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-9e95c4d52dba40a9a74616c0fd91033c2023-08-02T09:17:14ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-08-011410.3389/fpsyt.2023.11661911166191Psychiatric referrals to the general hospital emergency department: are we being effective?Shikma Keller0Einat Tilbor1Afnan Shwiki2Sharon Florentin3Sofia Laufer4Omer Bonne5Laura Canetti6Laura Canetti7Inbal Reuveni8Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychology, Hebrew University of Jerusalem, Jerusalem, IsraelDepartment of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelIntroductionGeneral hospital emergency departments (GHEDs) are notoriously overcrowded. This is caused, in part, by ineffective referrals, that is to say referrals that do not require medical examination or other interventions in the context of a general hospital. This study aims to investigate the contribution of psychiatric referrals to this issue, to identify potential determinants of these referrals and offer means to reduce them.Materials and methodsRetrospective data were collected from psychiatric admission files within a GHED of a tertiary-care city hospital over a 1 year period. Two experienced clinicians separately reviewed each file to determine rationale of referrals according to predetermined criteria.ResultsA total of 2,136 visits included a psychiatric examination, 900 (42.1%) were determined “effective,” and 1,227 (57.4%) were deemed “potentially ineffective.” The leading causes for potentially ineffective referrals to a GHED were psychiatric illness exacerbation (43.4%), and suicidal ideations (22%). Most referrals (66.9%) were initiated by the patient or their family, and not by a primary care physician or psychiatrist.ConclusionMore than half of the psychiatric referrals did not necessarily require the services of a general hospital, and may be more suitable for referral to a dedicated psychiatric facility. Ineffective referrals to the GHED pose a burden on general hospital resources, and may be less effective for the psychiatric patients. This calls for clear guidelines for the provision of optimal emergency treatment for mental-health patients.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1166191/fullgeneral hospital emergency departmentovercrowdingmental healthpsychiatric emergenciesappropriate referralsemergency psychiatry |
| spellingShingle | Shikma Keller Einat Tilbor Afnan Shwiki Sharon Florentin Sofia Laufer Omer Bonne Laura Canetti Laura Canetti Inbal Reuveni Psychiatric referrals to the general hospital emergency department: are we being effective? Frontiers in Psychiatry general hospital emergency department overcrowding mental health psychiatric emergencies appropriate referrals emergency psychiatry |
| title | Psychiatric referrals to the general hospital emergency department: are we being effective? |
| title_full | Psychiatric referrals to the general hospital emergency department: are we being effective? |
| title_fullStr | Psychiatric referrals to the general hospital emergency department: are we being effective? |
| title_full_unstemmed | Psychiatric referrals to the general hospital emergency department: are we being effective? |
| title_short | Psychiatric referrals to the general hospital emergency department: are we being effective? |
| title_sort | psychiatric referrals to the general hospital emergency department are we being effective |
| topic | general hospital emergency department overcrowding mental health psychiatric emergencies appropriate referrals emergency psychiatry |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1166191/full |
| work_keys_str_mv | AT shikmakeller psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT einattilbor psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT afnanshwiki psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT sharonflorentin psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT sofialaufer psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT omerbonne psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT lauracanetti psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT lauracanetti psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective AT inbalreuveni psychiatricreferralstothegeneralhospitalemergencydepartmentarewebeingeffective |