A retrospective look at length of stay for pediatric psychiatric patients in an urban emergency department.
Academic Article
Overview
abstract
OBJECTIVE: The objective of the study was to compare the length of stay (LOS) of patients with psychiatric diagnoses in a pediatric emergency department (ED) to that of patients with nonpsychiatric diagnoses. METHODS: This is a retrospective review of all patients younger than 19 years with psychiatric conditions, who presented to an urban teaching hospital ED with psychiatric symptoms, from January 2004 to December 2007. A control group of patients with nonpsychiatric diagnoses was selected over a random 4-day period. Emergency department LOS (in minutes) of nonpsychiatric versus psychiatric patients was compared. Length of stay was determined from the time of triage to disposition (discharge or admission). Patients with psychiatric diagnoses were further classified into 1 of 2 categories: major psychiatric diagnoses (bipolar disorder, psychoses, major depression, suicidal attempt or ideation, homicidal ideation, and hallucination) and minor psychiatric diagnoses (attention deficit/hyperactivity disorder, adjustment disorder, anxiety or panic attack, and behavioral issues). RESULTS: A total of 1468 patients with psychiatric diagnoses visited the ED. Three hundred eighty-two patients had major psychiatric diagnoses, and 1086 patients had minor psychiatric diagnoses. The control group (patients with nonpsychiatric diagnosis) consisted of 345 patients. Mean LOS of nonpsychiatric patients was 160 minutes (95% confidence interval [CI], 142-177 minutes); LOS for minor psychiatric patients was 737 minutes (95% CI, 670-803 minutes) and 1127 minutes for major psychiatric patients (95% CI, 972-1283 minutes). On the other hand, median LOS of nonpsychiatric patients was 129 minutes; minor psychiatric patients, 328 minutes; and major psychiatric patients, 437.5 minutes. Kruskal-Wallis test showed a significant difference between each group with P = 0.0001. CONCLUSIONS: The LOS was significantly higher in patients with psychiatric diagnoses. The mean and median for LOS both rose steadily from nonpsychiatric to major psychiatric diagnoses.
