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At least 19 recordsLinked to original sources
PubMed1983

The psychiatric clinical specialist's impact on psychiatric emergency services.

Psychiatric emergency services have evolved into more comprehensive programs during the past two decades. With this evolution other disciplines have gained access to the services and integrated their expertise and philosophy into the daily care of patients. Nursing has been an integral part of this process and contributed its perspective in nursing care. This paper outlines the development of psychiatric emergency services with a special emphasis on the contribution of nursing specialists who have developed their role within the psychiatric emergency service. What has been unique about the nursing contribution is the attention to individualizing patient care and modifying treatment approaches to meet the patients' needs and interests in psychiatric treatment. Additionally, nursing has complemented the physician's role by developing expertise in assessment that is both psychologically and biologically oriented. Nursing's future contribution to psychiatric emergency services should address mechanisms for tracking patients who enter the psychiatric emergency service system with an emphasis on linkage with other programs or resolution of the crisis episode.

Crisis Intervention↗
PubMedDate not supplied

Organization and function of academic psychiatric emergency services.

Psychiatric emergency services (PES) are evolving as freestanding, parallel components of emergency departments at many tertiary care medical centers in the U.S. While PES facilities provide an increasing percentage of first-line care for patients with psychiatric crises, the services they provide and their interactions with medical emergency services have not been systematically assessed. The purpose of this study was to examine PES structure, care processes, patient characteristics and relationship with medical emergency services by surveying PES directors with a 70-item questionnaire about PES facilities in 1998. This report presents information about staffing adequacy, medical evaluation and other procedures, length of stay, and aftercare. The response rate was 91% (n=51), and most sites (>90%) were academic training sites. A large percentage (92%) of PES sites were open 24 h a day, 7 days a week, and 94% had an attending psychiatrist present at least 8 h daily. PES psychiatrists performed initial medical evaluation at 55% of sites and were often responsible for medical clearance. Pharmacologic therapy was routinely initiated for patients being admitted in 92% of facilities and for patients being released in 70% of facilities. Mean (SD) length of stay in the PES was 9.0 (11.3) hours. The PES facilities were effective at referring patients to aftercare, and 51% of PES sites provided follow-up care. However, 69% of respondents reported inadequate referral options for patients with substance abuse. The mean recidivism rate was 18%, primarily attributed to substance abuse and medication noncompliance. The results of this survey show that PES facilities are organizationally complex units in which staff routinely perform medical clearance, initiate treatment, and coordinate aftercare. Our findings highlight the importance of adequate medical training for PES psychiatrists, the need for improved aftercare programming, and better access to substance abuse treatment for discharged patients.

Academic Medical Centers↗
PubMedDate not supplied

Use of restraints and pharmacotherapy in academic psychiatric emergency services.

Psychiatric emergency services (PES) are an increasingly important component of mental health services. To assess the type and scope of services delivered in the PES setting, the American Association for Emergency Psychiatry sponsored an Expert Consensus Panel Survey of these services in 1999. The questionnaire was mailed to medical directors of PES facilities with 91% (n = 51) responding. More than 90% of the respondents were teaching sites. Restraints were reportedly used in a mean of 8.5% of presentations for a mean of 3.3 h per episode. Restraint utilization correlated with the percentage of psychotic patients treated, but not with a wide variety of other patient and service variables. Involuntary medications were used in 16% of cases, though in oral form in 29% of those cases. A large majority (94%) endorsed mild sedation permitting further assessment as the appropriate endpoint and rejected sleep or heavy sedation as an endpoint (82%). Benzodiazepines received the strongest endorsements and 82% indicated it would be appropriate to administer a benzodiazepine alone for agitation first and initiate antipsychotic treatment subsequently if appropriate. When there is no history of prior antipsychotic exposure, 60% favored a benzodiazepine alone. However, given a history of previous antipsychotic treatment, only 8% endorsed this strategy. Most respondents (78%) preferred to use oral medication for treating behavioral emergencies, whenever possible but 70.3% reported regular use of an IM combination of a benzodiazepine and high-potency typical neuroleptic when necessary. In addition to managing emergencies, 82% of services initiated standing medications for patients being admitted to hospital settings and 70% initiated regular medication treatments for patients being released to the community. Of patients started on oral antipsychotics, 42% received an atypical antipsychotic. Reflecting medication characteristics of particular importance in emergency settings, most respondents (92%) cited selective serotonin reuptake inhibitors as the preferred type of antidepressant, and divalproex or related compounds (90%) for treatment of bipolar disorder in the PES.

Academic Medical Centers↗
PubMed1990

[Emergency psychiatric services and emergency hospitalization].

Based on an analysis of hospitalization of mental patients in Krasnodar during the five-year period it has been demonstrated that despite the fact that the number of hospitalized patients generally decreased, the portion of the patients admitted to hospital via ambulance rose. Analysis of the group of mental patients admitted to the psychiatric hospital by means of ambulance, particularly of those suffering from schizophrenia enables raising a question about the necessity of perfecting criteria for hospitalization including urgent without the patient's knowledge.

Adult↗
PubMed2005

Determinants of indicated versus actual level of care in psychiatric emergency services.

OBJECTIVE: This study was undertaken to improve understanding of the admission decision process by distinguishing between the clinically indicated level of care and actual level-of-care decisions in emergency psychiatry. METHODS: Clinicians in emergency psychiatric services in Rotterdam, The Netherlands, prospectively rated 720 patients by using the Severity of Psychiatric Illness Scale and collected information on demographic, clinical, and contextual parameters. The clinically indicated level of care and actual level-of-care decisions were studied independently, by using multivariate logistic regression analyses. The decision-making process was divided into three consecutive steps: evaluation of clinically indicated inpatient or outpatient level of care (step 1), voluntary or involuntary admission (step 2), and actual admission of patients for whom voluntary admission was indicated (step 3). RESULTS: Each step was determined by separate factors. Specifically, clinically indicated admission (step 1) was associated with family or friends' desire for admission (odds ratio [OR]=3.7), previous admissions (OR=2.9), symptom severity (OR=2.7), and personality disorder (OR=.4). Involuntary admission (step 2) was associated with lack of motivation (OR=5.7), symptom severity (OR=3.7), time of referral (OR=3.5) and danger to self or others (OR=2.7). Actual voluntary admission (step 3) was associated mainly with bed availability (OR=8.7). The overall percentage of correctly predicted cases was 82 percent for all steps in the decision process. CONCLUSIONS: This study showed that each step in the admission decision process is determined by a unique set of variables and provided evidence that contextual factors influence decision making. Guidelines for voluntary admission and civil commitment need to be based on the results of studies that distinguish between the clinical needs of patients and contextual factors.

Adolescent↗
PubMed2002

Patient and contextual factors related to the decision to hospitalize patients from emergency psychiatric services.

OBJECTIVE: Mental health care reform has brought an increasing emphasis on community care, with concomitant reductions in inpatient psychiatric resources. Hospitalization remains a necessary and integral component of the mental health care system, but it is taking on a more specialized role. Examining the circumstances in which hospitalization is indicated can help clarify emergency psychiatric practices and determine whether patients' needs are being met within this changing environment. This pilot study examined the impact of selected patient and contextual characteristics on the decision to admit patients to inpatient psychiatric units and assessed the utility of the Severity of Psychiatric Illness (SPI) scale for monitoring clinical practice in emergency psychiatric services. METHODS: Crisis workers in two emergency psychiatric services crisis teams in Toronto, Canada, used the SPI in the assessment of 205 visitors to the services during the winter of 1998-1999. Contextual characteristics, including bed availability, service site, and the admitting physician's level of training, were recorded. Multivariate logistic regression was used to assess the relative contribution of patient and contextual variables in the admission decision. RESULTS: The severity of axis I symptoms and difficulties with self-care were significantly associated with the decision to admit. Site, bed availability, and the admitting physician's level of training did not appear to be associated with clinical decisions. CONCLUSIONS: Patients with the most need are being admitted to inpatient units despite significant systemic pressures on inpatient services. The SPI is a useful and discriminating tool for evaluating clinical practice in emergency services.

Adult↗
PubMed1992

A mobile crisis program: collaboration between emergency psychiatric services and police.

An emergency psychiatry-mobile crisis program was established in 1987 in Charleston, South Carolina, linking professionals from the mental health center, the university, and the local police department. The program has two goals: to provide emergency psychiatric services to persons in the community and to train psychiatric residents in crisis intervention. Mental health staff act as consultants to the police in some situations, and in others the police provide security. The authors describe the development of the collaboration with police and important features of the program. Three cases illustrate how such collaboration can be of mutual benefit and can save lives.

Adult↗
PubMed1979

Deployment, supervision and decision-making of residents in an emergency psychiatric service.

A lessening of personal discomfort felt by residents on-call in the Emergency Psychiatric Service has resulted from changes in the frequency of being on-call, exclusion of beginning residents from duty and arranging for the presence of a faculty psychiatrist for one or two hours during each on-call period. Coincidental significant reductions in the number of cases admitted to hospital and reductions in the proportion of discrepancies between diagnoses made by the emergency resident and those made later by inpatient unit staff have been described. The relationship of the changes in resident experience to the reduction in admissions and decreased proportion of diagnostic discrepancy has been discussed using a model of the process of emergency psychiatric admission described earlier by Bartolucci et al. (1). Less isolation, anxiety and some increased experience on the part of the psychiatric residents on duty in the Emergency Psychiatric Service results in greater awareness and better appraisal of the non-medical aspects of psychiatric emergencies.

Anxiety↗
PubMed1983

The treatment capabilities of psychiatric emergency services.

The author describes the treatment capabilities of a psychiatric emergency service. Psychiatric emergency facilities have become an integral part of general hospitals and the mental health system, and are used increasingly by patients. The author defines the treatment goals of psychiatric emergency care as, (1) symptomatic relief, (2) maintenance of ongoing treatment, and (3) referral and facilitation for entering treatment. The treatment techniques include an integration of psychologic, pharmacologic, and physical management principles. The qualities needed by an emergency service clinician to work in such a setting are described. Implications for training and research are discussed.

Crisis Intervention↗
PubMed2000

[Comparison of the responsibility spectrum of a community psychiatric emergency service and outpatient emergency care in a psychiatric clinic].

PURPOSE: The need for psychiatric crisis services is generally accepted. Additional to traditional crisis clinics which are located in general or psychiatric hospitals in recent years also special community crisis services were implemented. The question is whether there are differences in patients and type of care between traditional and new services. METHODS: In this study empirical data are reported on reasons for contact, on patients and on interventions for a hospital based crisis clinic and a community crisis service. 132 service and 364 clinic contacts were recorded. RESULTS: There were more neurotic patients in the community service and more psychotic patients in the clinic. In both services inpatient care had to be arranged in one third of the cases. In the hospital based crisis service fewer legal commitments were necessary. A speciality of the community crisis service is the possibility to look after patients in their homes. CONCLUSION: Both services have similar features, but there are also differences which show that the new service offers new possibilities of care.

Ambulatory Care↗
PubMed2000

Psychiatric patients' perceptions of waiting time in the psychiatric emergency service.

Recent customer service surveys have indicated that patients in the Psychiatric Emergency Service (PES) are increasingly dissatisfied with the "waiting" time connected with expanded services. This study examined the impact of six interventions that altered the environment of waiting patients and their resulting perceptions of time spent in PES. The interventions were communication (three styles), relaxing music, educational videos, and recreational activities. Each intervention was conducted for 7 days, followed by 7 days of no intervention. Patients completed a Time Assessment Tool that measured expectations of, perceptions of, and satisfaction with waiting time. These data were compared to actual time, as reflected on the log maintained in the PES. In general, environmental interventions reduced patients' perceived time, compared to no intervention. Significantly, interacting with patients with caring and concern consistently resulted in a reduced perception of waiting time, compared to the other interventions.

Adult↗
PubMed2006

Hospital based psychiatric emergency services: a guide to service delivery and clinical best practices.

Hospital based psychiatric emergency services play an integral role in the initiation of mental health and psychiatric service delivery worldwide. Whenever possible, hospital based psychiatric emergency services should be delivered in accordance to best practice standards. Unfortunately, no such standards exist internationally in the case of hospital based psychiatric emergency services. This paper represents an attempt to rectify this problem. International mental health and psychiatric literature pertaining to hospital based psychiatric emergency services was reviewed and a guide to service delivery and clinical best practice was generated.

Delivery of Health Care↗
PubMed1993

Characteristics of repeat users of a psychiatric emergency service.

OBJECTIVE: Patients who visited a psychiatric emergency service were studied to determine whether repeat visitors, who consume a disproportionate share of services, could be identified by demographic and diagnostic characteristics. METHODS: Data were obtained from a semistructured diagnostic interview given to all 16,257 persons who made 29,214 visits to an urban psychiatric emergency service in Pittsburgh, Pennsylvania, from 1985 to 1989. Patients were categorized into four groups based on the number of visits in the five-year period. Patients in group 1 made a single visit, while those in group 2 averaged less than one visit per year; those in group 3 made one or two visits per year, and those in group 4, more than two visits per year. RESULTS: Groups 3 and 4 constituted 5.1 percent of the sample but made 27.1 percent of the total visits. Repeat users were significantly more likely to be male, younger, unmarried, unemployed, and nonwhite and to have diagnoses of schizophrenia, other psychotic disorders, and personality disorders. CONCLUSIONS: Repeat users of psychiatric emergency services appear to have demographic and diagnostic characteristics that may permit their early identification. For such patients, implementation of alternative management strategies, such as intensive case management, may reduce their use of services.

Adolescent↗