Emergency department referrals to liaison psychiatry: Characteristics and outcomes

Northamptonshire liaison psychiatry service provides mental health assessment and care for adult patients at the county’s two major acute hospitals (800-bed Northampton General Hospital and 600-bed Kettering General Hospital), including people attending the hospitals’ two round-theclock emergency departments (EDs) (Bolton et al., 2016; Tahir et al., 2019). Northamptonshire is an English county of mixed urban and rural regions that have marked socioeconomic and ethnic variability, and a total population of approximately 750,000 persons. We aimed to determine the characteristics and outcomes of ED patients referred to liaison psychiatry. Thus, electronic health records of patients (17 years old and above) referred to liaison psychiatry by EDs and their attached wards during the month of November 2019 were retrospectively reviewed to obtain the relevant clinical information, which was subsequently analysed using descriptive statistics. Statistical significance was set at p < . 05. Our study revealed that 235 ED referrals were made to Northamptonshire liaison psychiatry service during November 2019 (Table 1). The mean age (SD) of patients was 35 (15) years and 122 (52%) of them were female. Three quarters of referrals were for suicidal ideation or behaviour. One in two patients was found to have had a diagnosis of personality disorder, whereas one third of them were already under the care of secondary mental health services. Following assessment by the liaison psychiatry clinicians, three quarters of patients were discharged, a tenth of them were referred on to the home treatment service while another tenth were admitted into a psychiatric hospital. No cases of suicide among patients in the sample were reported at the point of data collection in April 2020. Association between patients’ different characteristics and outcomes were examined using Mann–Whitney U test for age and Pearson chi-square test for other variables. Comparison between males and females (Table 1) revealed statistically significant gender differences in terms of diagnosis and reason for referral but not in outcomes. Furthermore, patients who were referred due to psychotic symptoms were more likely (47%) to be admitted to a psychiatric unit (p < .001) compared with those referred for suicidal ideation or behaviour (9%) or patient referred for other reasons, of whom none was hospitalised. Geographical distribution analysis showed correlation between socioeconomic deprivation and ED referrals to liaison psychiatry. Three quarters of referrals were for patients residing in the three regions with highest socioeconomic deprivation scores (Northampton; 42.1%, Wellingborough; 23.8%, and Corby; 8.1%) and half the county’s population. On the other hand, there were very few referrals for patients from the region with the lowest deprivation scores (South Northamptonshire; 0.9%) although it has 12.6% of the county’s population. In view of the evidence that patients who attend hospital for self-harm are at high risk of suicide (Geulayov et al., 2019), and our finding that those patients represented the vast majority of ED referrals to our liaison psychiatry service, it is of paramount importance that ED and liaison psychiatry clinicians receive adequate training in suicide risk assessment, and that appropriate support and follow-up arrangements are provided. The finding that the majority of patients had personality disorders is in line with existing evidence (Shaikh et al., 2017) and it emphasises the need for robust support and crisis prevention planning for this patient group. Nonetheless, this study has a number of limitations. First, it only examined referrals during 1 month of the year and, thus, it would not have captured any potential variation in the pattern of referrals over a longer period of time. Second, data distribution may have been skewed towards ED frequent attenders which was not accounted for in this study. Third, patients residing in the peripheral regions of Northamptonshire may have accessed EDs in neighbouring counties, potentially resulting in Emergency department referrals to liaison psychiatry: Characteristics and outcomes