Emergency psychiatric assessment, treatment, and healing (EmPATH) unit decreases hospital admission for patients presenting with suicidal ideation in rural America.

Autor:	Kim, Allison K., Vakkalanka, J. Priyanka, Van Heukelom, Paul, Tate, Jodi, Lee, Sangil
Předmět:	PATIENT aftercare RELATIVE medical risk ACADEMIC medical centers CONFIDENCE intervals EMERGENCY services in psychiatric hospitals RURAL conditions TIME REGRESSION analysis RISK assessment SUICIDAL ideation TREATMENT effectiveness HUMAN services programs SUICIDAL behavior HOSPITAL care DESCRIPTIVE statistics PSYCHIATRIC emergencies OUTPATIENT services in hospitals
Zdroj:	Academic Emergency Medicine; Feb2022, Vol. 29 Issue 2, p142-149, 8p
Abstrakt:	Objectives: The objective was to evaluate the impact of an emergency psychiatric assessment, treatment, and healing (EmPATH) unit in the emergency department (ED) on hospital admissions, ED length of stay, and 30‐day follow‐up for patients presenting with suicidal ideation or attempt. Methods: This study was a before‐and‐after analysis of introducing the EmPATH unit within a Midwestern academic medical center on outcomes of adult patients (≥18 years) presenting with suicidal ideation or suicidal attempt. The primary outcome in this study was the change in proportion of inpatient psychiatric admission of suicidal patients presenting to the ED before and after implementation of the EmPATH unit. Secondary outcomes compared were changes in proportion of any admission, incomplete admission defined as discharge from the ED after admission request placed, outpatient follow‐up, return ED visits within 30 days of admission, and ED boarding time. Association between the EmPATH unit implementation and categorical outcomes were determined using log‐binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs). Continuous outcomes were log‐transformed and generalized estimating equations were used to examine as the mean difference by time period. Results: There were 962 patients presenting with suicidal ideation (n = 435 before EmPATH unit, n = 527 after EmPATH unit). Compared to the pre‐EmPATH‐unit period, there was a reduction in psychiatric admission (RR = 0.48, 95% CI = 0.40 to 0.56), any admission (RR = 0.65, 95% CI = 0.58 to 0.73), incomplete admission (RR = 0.22, 95% CI = 0.11 to 0.43), and 30‐day return to the ED (RR = 0.74, 95% CI = 0.56 to 0.98). ED boarding time among admitted patients was reduced by approximately two‐thirds both in admitted patients (RR = 0.34, 95% CI = 0.30 to 0.39) and among those with incomplete admissions (RR = 0.37, 95% CI = 0.23 to 0.61). There was a 60% increase in a 30‐day follow‐up care established at the time of discharge (RR = 1.60, 95% CI = 1.40 to 1.82). Conclusions: The introduction of the EmPATH unit has improved management of patients presenting to the ED with suicidal attempts/ideation by reducing ED boarding and unnecessary admissions and establishing post‐ED follow‐up care. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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