Weekday Psychiatry Faculty Rounds on Emergency Department Psychiatric Patients Reduces Length of Stay

Objectives In the face of increasing volume of emergency department (ED) patients with primary psychiatric illness and increasing length of stay (LOS), a department of psychiatry initiated a program whereby faculty members of the department of psychiatry from a hospital conducted rounds in the ED each weekday on these patients. Methods A retrospective data review was performed to assess the effect of these rounds on the LOS and disposition of these patients. The LOS and dispositions of subjects before and after the initiation of psychiatry rounds were compared, with a 2-month washout period between. Subjects had a primary psychiatric diagnosis with a LOS of 12 hours or greater. The LOS and disposition of each subject was queried from the hospital data system. Quantile regression analysis and Fisher's exact test were used as appropriate. Results There were 355 subjects in the preimplementation period and 512 in the postimplementation period. The proportion of patients discharged remained unchanged (preimplementation 49.6%, 95% confidence interval [CI] = 44.3 to 54.9; postimplementation 49.0%, 95% CI = 44.6 to 53.4), but more patients were admitted to the hospital (24.2%, 95% CI = 19.9 to 29.0 vs. 32.8, 95% CI = 28.8 to 37.1) and fewer were transferred to other psychiatric facilities (25.6%, 95% CI = 21.2 to 30.5 vs. 18.0% 95% CI = 14.7 to 21.6; p = 0.005 by Fisher's exact test). Quantile regression demonstrated that among subjects with the longest LOS, those in the postimplementation group experienced a reduction in their waiting times. Conclusions Weekday rounds in the ED by psychiatry faculty are associated with a reduction in the LOS for psychiatric patients, mainly due to reduced LOS of those patients with the longest stays. Resumen Las Visitas en Dias Laborables del Facultativo de Psiquiatria a los Pacientes Psiquiatricos del Servicio de Urgencias Reducen el Tiempo de Estancia Objetivos En relacion con el incremento del volumen de pacientes con patologia psiquiatrica primaria y el aumento del tiempo de estancia (TDE), un departamento de psiquiatria inicio un programa a traves del cual los facultativos del servicio de psiquiatria de un hospital llevaron a cabo visitas a estos pacientes en el servicio de urgencias (SU) cada dia laborable. Metodologia Se realizo una revision retrospectiva de los datos para valorar el impacto de estas visitas en el TDE y la ubicacion de estos pacientes. Se comparo el TDE y la ubicacion de los sujetos antes y despues del inicio de las visitas psiquiatricas con un periodo de dos meses entre ambas. Los sujetos tenian un diagnostico psiquiatrico primario con un TDE de 12 horas o mas. El TDE y la ubicacion de cada sujeto se consultaron en el sistema de datos del hospital. Se utilizo un analisis de regresion y el test exacto de Fisher. Resultados Hubo 355 pacientes en el periodo preintervencion y 512 en el periodo postintervencion. La proporcion de pacientes dados de alta permanecio sin cambios (preintervencion 49,6%, IC 95% = 44,3 a 54,9; post-intervencion 49,0%, IC 95% = 44,6 a 53,4). Sin embargo, se ingresaron mas pacientes en nuestro hospital (24,2%, IC 95% = 19,9 a 29,0% vs. 32,8%, IC 95% = 28,8 a 37,1%) y se trasladaron menos a otros centros psiquiatricos (25,6%, IC 95% = 21,2 a 30,5% vs. 18,0% IC 95% = 14,7 a 21,6%) (p = 0,005 mediante test exacto de Fisher). La regresion mostro que los sujetos con los mayores TDE fueron los que experimentaron una reduccion de los TDE dentro del grupo postintervencion. Conclusiones Las visitas en dias laborable a los SU por parte de un facultativo de psiquiatria reducen el TDE para los pacientes psiquiatricos mediante la reduccion del TDE en aquellos pacientes con estancias mayores.