What general emergency nurses want to know about mental health patients presenting to their emergency department

This paper presents the findings of a qualitative project conducted to investigate the education and training requirements that non-mental health trained emergency nurses need to enable them to effectively care for psychiatric patients presenting to a West Australian emergency department. Non-mental health trained nurses are ill-equipped in their psychiatric knowledge, assessment and communication skills to provide best possible care to the one in ten patients presenting to the emergency department with a complex mental health issue. The area of assessment and management of mental health patients in the emergency department is a complex one and staff are required to assess, triage and manage these patients appropriately. Furthermore, with aggression and violence increasing, emergency department nurses are concerned about their safety in the workplace. Focus groups with emergency nurses and semi-structured interviews with subject matter experts were conducted at one West Australian teaching hospital. The findings of the project demonstrated that these nurses considered that customer focus, workplace aggression and violence, psychiatric theory, mental health assessment and chemical dependence as key learning areas. These findings will form a platform for further education and training for ED staff.     

Clinician perspectives of a mental health consumer flow strategy in an emergency department

Background

The increasing number of presentations to hospital emergency departments has seen the implementation of a variety of strategies in an effort to enhance care delivery and care continuity. One such strategy was designed and implemented to improve the transition of mental health consumers presenting to an Australian emergency department and admitted to a hospital mental health ward.

Emergency department care for patients with mental health problems,a longitudinal registry study and a before and after intervention study

ObjectiveTo describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow.MethodsA longitudinal design was used to assess number of MH presentations and LOS during a 3-year period (2014–2016). In 2017, we introduced a PIT during ED peak hours, to reduce LOS for patients with MH problems. We evaluate the effects of the PIT on patients’ LOS with an 18-month before and after intervention study (2017–2018).ResultsTotal number of ED presentations increased with 4%. Total number of MH presentations increased with 23% from 2014 to 2016. LOS increased by 28 min (95 min vs. 123 min) for all presentations, while not changing for MH presentations (2014: 195 min, interquartile range (IQR) 120–293 and 2016: 190 min, IQR 116–296). In the before and after intervention study, number of MH presentations increased with 36% while LOS decreased with 46 min (p < 0.001).ConclusionsThe number of MH presentations increased over the three years while LOS remained similar. In the before and after intervention study, number of presentations increased even more while LOS decreased significantly. Specialist psychiatric input reduces ED LOS.     

Poor performance of the modified early warning score for predicting mortality in critically ill patients presenting to an emergency department

BACKGROUND:

This study was undertaken to validate the use of the modified early warning score (MEWS) as a predictor of patient mortality and intensive care unit (ICU)/ high dependency (HD) admission in an Asian population.

METHODS:

The MEWS was applied to a retrospective cohort of 1 024 critically ill patients presenting to a large Asian tertiary emergency department (ED) between November 2006 and December 2007. Individual MEWS was calculated based on vital signs parameters on arrival at ED. Outcomes of mortality and ICU/HD admission were obtained from hospital records. The ability of the composite MEWS and its individual components to predict mortality within 30 days from ED visit was assessed. Sensitivity, specificity, positive and negative predictive values were derived and compared with values from other cohorts. A MEWS of !4 was chosen as the cut-off value for poor prognosis based on previous studies.

RESULTS:

A total of 311 (30.4%) critically ill patients were presented with a MEWS !4. Their mean age was 61.4 years (SD 18.1) with a male to female ratio of 1.10. Of the 311 patients, 53 (17%) died within 30 days, 64 (20.6%) were admitted to ICU and 86 (27.7%) were admitted to HD. The area under the receiver operating characteristic curve was 0.71 with a sensitivity of 53.0% and a specificity of 72.1% in addition to a positive predictive value (PPV) of 17.0% and a negative predictive value (NPV) of 93.4% (MEWS cut-off of !4) for predicting mortality.

CONCLUSION:

The composite MEWS did not perform well in predicting poor patient outcomes for critically ill patients presenting to an ED.KEY WORDS: Modified early warning score, Emergency department, Outcomes, Triage     

急诊科护士睡眠质量和心理健康状况的调查及分析

目的:调查分析急诊科护士的睡眠质量和心理健康状况.方法:采用匹兹堡睡眠质量指数量表(PSQI)和症状自评量表(SCL-90),对本市两所三级甲等医院68名急诊科护士和70名普通内科护士的睡眠质量和心理健康状况进行调查.结果:急诊科护士匹兹堡睡眠质量指数量表总分和各因子得分均高于普通内科护士,差异有显著性(P＜0.05,P＜0.01).症状自评量表中除敌对、偏执因子外,其余因子分及总分均高于普通内科护士,有显著性差异(P＜0.01).急诊科护士除睡眠时间这个成分外,其余匹兹堡睡眠质量指数量表各成分与症状自评量表各因子及总分间呈正相关关系.结论:急诊科护士睡眠质量和心理健康水平值得关注,需采取多种措施改善急诊科护士的睡眠质量和提高其心理健康水平,以保证护理安全和质量.     

Profiling police presentations of mental health consumers to an emergency department

Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.     

Presenting patterns of dermatology conditions to an Australian emergency department

Approximately 5% 8% of emergency department (ED) presentations are due to a dermatological condition. This study aimed to identify and characterise patients with skin conditions presenting to a busy ED. METHODS: A 5-year retrospective study on patients with dermatological conditions presenting to the Princess Alexandra Hospital ED in Brisbane, Australia was performed. Electronic medical records were used to compare demographics and admission status of the dermatology group and the total ED group presentations. A prospective survey was conducted on low priority triage (triage 4 and 5) patients identifying reasons presenting to the ED. RESULTS: Of a total 281,718 ED presentations, 11,748 dermatology presentations were identified between January 2012 to December 2016. Of the dermatology presentations, 41.5% were female and had an average age of 47. The most common dermatology presentations were cellulitis, abscess, rash unspecified, and ulcer. Of those admitted, 36% were female, average age was 53, mean length of stay of 294 minutes and 83.1% had an infectious aetiology. Of triage 4 and 5 presentations, 66% patients we approached had been seen by a health practitioner prior to coming to the ED. CONCLUSION: Within the population presenting with a skin related condition to the Princess Alexandra Hospital ED, characteristics associated with admission include male sex, older age, and an infectious etiology. This data may help ED clinicians decide on the discharge disposition of these patients. There may be a role for streamlined admissions for skin related infections, or improved hospital in the home services to support this group.     

Effects of seasonality and daylight savings time on emergency department visits for mental health disorders

ObjectivesEmergency Department (ED) utilization accounts for a large portion of healthcare services in the US. Disturbance of circadian rhythms may affect mental and behavioral health (MBH) conditions, which could result in increased ED visits and subsequent hospitalizations, thus potentially inducing staffing shortages and increasing ED wait time. Predicting the burden of ED admissions helps to better plan care at the EDs and provides significant benefits. This study investigates if increased ED visits for MBH conditions are associated with seasonality and changes in daylight savings time.MethodsUsing ED encounter data from a large academic medical center, we have examined univariate and multivariate associations between ED visits for MBH conditions and the annual time periods during which MBH conditions are more elevated due to changes in the seasons. We hypothesize that ED visits for MBH conditions increase within the 2-week period following the daylight savings time changes.ResultsIncreased MBH ED visits were observed in certain seasons. This was especially true for non-bipolar depressive illness. We saw no significant changes in MBH visits as associated with changes in the daylight savings time.ConclusionsData do not provide conclusive evidence of a uniform seasonal increase in ED visits for MBH conditions. Variation in ED MBH visits may be due to secular trends, such as socioeconomic factors. Future research should explore contemporaneous associations between time-driven events and MBH ED visits. It will allow for greater understanding of challenges regarding psychiatric patients and opportunities for improvement.     

Increased access to urgent care centers decreases low acuity diagnoses in a nearby hospital emergency department

Objective

We studied the impact four new urgent care centers (UCCs) had on a hospital emergency department (ED) in terms of overall census and proportion of low acuity diagnoses from 2009 to 2016. We hypothesized that low acuity medical problems frequently seen in UCCs would decrease in the ED population. Since Medicaid was not accepted at these UCCs, we also studied the Medicaid vs non-Medicaid discharged populations to see if there were some differences related to access to urgent care.

The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study

BACKGROUND: Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition.     

The Affordable Care Act: Disparities in emergency department use for mental health diagnoses in young adults

BACKGROUND: There is little consensus as to the effects of insurance expansion on emergency department (ED) utilization for mental health purposes. We aimed to study the race specific association between the dependent coverage provision of the Affordable Care Act (ACA) and changes in young adults' usage of emergency department services for psychiatric diagnoses.