Psychiatry and Mental Health

Biography

Biography: Huma Iram

Abstract

Introduction: Psychiatric boarding is a major contributing factor for emergency department crowding which is associated with increased morbidity and mortality. Emergency departments are acting as a safety net for boarding psychiatric patients, due to difficulty securing the already limited inpatient psychiatric care and they frequently need to be transferred to another hospital. This study was done to look at the length of stay for psychiatric patients boarding in the emergency department at Hamad General Hospital which is the largest government hospital in the state of Qatar. Several parameters like the number of psychiatric patients who leave the ER against medical advice or absconded, whether they return afterwards within a week or not and also, how many of the boarding patients were treated and discharged without being transferred to the psychiatry hospital, were also looked into. According to Zellar et al (2014), the factors contributing to the psychiatric boarding include lack of screening tools or evaluations by qualified psychiatric clinicians and a lack of appropriate levels of outpatient care. Psychiatry consultation liaison team in Hamad Medical Corporation was established in the ED in 2014 who reviews boarding patients on a daily basis including weekends. This study also looked at whether the C-L team helped to reduce the number of psychiatric boarding patients in the ED.

Method: Facility-based descriptive analytical cross-sectional retrospective study was carried out between the months of January 2017 and April 2017 for the boarding psychiatric patients at Hamad hospital emergency department, to determine the length of stay and consequences after admission order by psychiatry medical staff. All patients regardless of their gender, age or nationality were included. Excluded patients were the patients for consultations only and no admission order was issued for them. Data was analyzed using SPSS software.

Result: Our study showed that 97 (27.2%) of the patients were of Qatari origin, 138 (38.7%) were of Asian origin, followed by African as 63 (17.6%) and the rest from other countries. 95 patients (26.6%) spent less than 12 hours in the emergency prior to being transferred to psychiatry hospital. 147 (41.2%) spent between 12-23 hours, 31 (8.7%) spent between 24-35

hours, 26 (7.3%) spent between 36-47 hours, 16 (4.5%) spent between 48-59 hours, 16 (4.5%) spent between 60-71 hours and 26 patients (7.3%) spent more than 72 hours. It was found that out of the 357 boarding patients, only 95 (26.6%) spent less than 12 hours in the ED while 262 (73.4%) patients spent more than 12 hours. On an average, patients on either kind of risk precautions (suicide or absconding) spent less time in the ER and were transferred earlier than those not on precautions. From the patients who left the ED it was found that from the 65 patients discharged by the liaison team 3 came back with in 1 week, from the admitted transferred patients 16 come back from the DAMA patients (Discharged against the medical device) zero come back from the 19 absconded patients 5 came back P value is 0.001

Recommendation: To ensure a safer and more secure alternative to psychiatric patients boarding in the emergency room, along-with equipping emergency department with well-trained nursing staff and doctors to care for these patients when they do require boarding at the ED. To increase bed capacity for acute patients who do need admission in order to move them swiftly out of the emergency room. To ensure greater use of community resources for safe disposition of these patients.

Conclusion: Study by Nicks and Manthey (2012) found that the total length of stay of psychiatric patients waiting in ED was 18.2 hours and for non-psychiatric patients was 5.7 hours. Majority of the patients in our study stayed in ED for more than 24 hours. Our study found the majority of the patients discharged by the C L team did not return back to E R hence were considered clinically appropriate and reduced the burden of boarding patients in the ER. Qatar mental health strategy highlights plans for expansion of psychiatric services including increasing the number of psychiatric beds and community services, which is likely to improve the current situation of boarding patients.