The Impact of Behavioral Health Patients on a Pediatric Emergency Departmentʼs Length of Stay and Left Without Being Seen
| Autor: | Heather Conrad, Kathryn A. Hollenbach, Tiffani A Barham, Karen L Ferran, Keri L. Carstairs, Daniel L Gehlbach |
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| Rok vydání: | 2018 |
| Předmět: |
Pediatric emergency
medicine.medical_specialty Waiting Lists Logistic regression Tertiary care 03 medical and health sciences Patient Admission 0302 clinical medicine 030225 pediatrics Retrospective analysis Humans Medicine Child Retrospective Studies business.industry Mental Disorders 030208 emergency & critical care medicine Retrospective cohort study General Medicine Odds ratio Emergency department Length of Stay Confidence interval Hospitalization Crowding Pediatrics Perinatology and Child Health Emergency medicine Emergency Medicine Emergency Service Hospital business |
| Zdroj: | Pediatric Emergency Care. 34:584-587 |
| ISSN: | 0749-5161 |
| DOI: | 10.1097/pec.0000000000001565 |
| Popis: | OBJECTIVE Emergency department (ED) boarding of admitted patients negatively impacts ED length of stay (LOS). Behavioral health (BH) patients are often challenging to safely discharge. We examined the association between daily BH census and non-BH LOS and left without being seen (LWBS) rates. METHODS Retrospective analysis of BH and non-BH patients at a high-volume tertiary care pediatric ED from December 2014 to June 2016 examined the association between BH patients and non-BH LOS and LWBS rates. Behavioral health patients were identified by presence of social work assessment and BH chief complaint and/or final diagnosis. Data were analyzed using 1-sample test of proportions, Student t test, Spearman and Pearson correlations, logistic regression, and odds ratios with 95% confidence intervals. RESULTS A total of 143,141 patients were seen, 3% (n = 4351) for BH presentations. Median LOS for discharged non-BH patients was 128 minutes compared with 446 minutes for BH patients. Daily LOS and bed hold hours were significantly longer for BH than for non-BH patients (P < 0.0001 for each analysis). After adjusting for ED census, daily BH census was significantly associated with increasing LWBS rates and non-BH LOS. CONCLUSIONS Behavioral health census and bed hold hours were significantly associated with increased LOS and LWBS rates and with our inability to meet desired LOS and LWBS rates. These associations support the existence of a threshold where the ED has reached capacity and is no longer able to absorb BH patients. Improving BH facility access may help improve overall pediatric ED patient care. |
| Databáze: | OpenAIRE |
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