Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry - Costanza, A.; Mazzola, V.; Radomska, M.; Amerio, A.; Aguglia, A.; Prada, P.; Bondolfi, G.; Sarasin, F.; Ambrosetti, J. (Medicina (Kaunas), 2020)
BACKGROUND AND OBJECTIVES: Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. MATERIALS AND METHODS: Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. RESULTS: In our sample (n = 763 total admissions for psychiatric conditions; n = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (</=65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients' trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST((R))) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. CONCLUSIONS: Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.
Keywords: journalArticle; Adolescent; Adult; Aged; Chi-Square Distribution; Emergency Service, Hospital/organization & administration/statistics & numerical; Female; Hospitals, Psychiatric/organization & administration/statistics & numerical data; Humans; Male; Mental Disorders/psychology/*therapy; Middle Aged; Retrospective Studies; Switzerland; Telemedicine/instrumentation/*methods/statistics & numerical data; data/*trends; depression; psychiatric emergency; psychotic episode; public mental health; substance use disorder; suicidal behavior; telepsychiatry