Wait Times for Psychiatric Patients in the ED

Hospital-based EDs are increasingly overburdened throughout the United States, resulting in a widening gap between the quality of emergency care Americans expect and the quality of care they actually receive. Longer lengths of stay within the ED have led to increased provider stress, greater risks for adverse events, and reduced patient satisfaction. Length of stay for patients seeking psychiatric care in the ED appears to be even longer than that of people without psychiatric concerns. This fact, when coupled with an increasing volume of psychiatric visits to EDs (23% growth between 2000 and 2007), have led to a real crisis for this vulnerable population in psychiatric distress. Identifying patient and clinical factors associated with long ED lengths of stay for psychiatric patients is critical to the development and implementation of targeted quality improvement efforts. To that end, my colleagues and I conducted a study to seek out these factors in this patient population and measure the effect of these variables on time spent within the ED. Our prospective analysis, published in the May 2, 2012 Annals of Emergency Medicine, involved 1,092 adults treated at one of five EDs. Secondary analyses considered patients discharged home and those who were admitted or transferred separately. Factors That Increase Hospital Length of Stay According to the findings from our study, the average length of stay in the ED was 11.5 hours for psychiatric patients, but lengths varied based on certain characteristics. Patients who were discharged home stayed 8.6 hours in the ED, while those admitted to psychiatric units within the hospital stayed 11.0 hours. Patients transferred to outside units within the local healthcare...