Peter Yang

Date of Award

9-8-2008

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Seth M. Powsner

Abstract

Many believe that psychiatric emergency services (PES) are misused, but there is little empiric data available addressing this issue. We investigated reasons patients actually sought emergent care, and whether alternative facilities could have addressed their needs. We reviewed 200 consecutive evaluations in a teaching hospital emergency department via chart review. Data collected included psychiatric history, substance use, and contributing etiologies. PES clinicians involved were asked directly about underlying reasons for emergent care and whether suitable care could have been provided in a less acute setting. Acute behavioral disturbances proved to be the most frequent reason for emergency visits. Half of all visits were because of uncontrollable, potentially uncontrollable, or unacceptable behavior. Direct provider referrals accounted for 31% of visits. Inability to cope with life events accounted for another 6%. Traditional psychiatric illness was a contributing factor in most visits (67.5%); other significant factors were relationship problems (20%) and substance abuse (16.5%). Alternative facilities could have taken care of 26% of visits. We found that the vast majority of emergent psychiatric visits warranted immediate attention; only a minority (13%) of visits were not urgent. Patients who did not require emergency care could have been served by walk-in clinics, drug detoxification facilities, or faster access to outpatient treatment.

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This is an Open Access Thesis.

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