Who Consult an Adult Psychiatric Emergency Department? Pertinence of Admissions and Opportunities for Telepsychiatry

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2020-06, Vol.56 (6), p.295
• Main Authors: Costanza, Alessandra, Mazzola, Viridiana, Radomska, Michalina, Amerio, Andrea, Aguglia, Andrea, Prada, Paco, Bondolfi, Guido, Sarasin, François, Ambrosetti, Julia
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Chi-Square Distribution; depression; Emergency Service, Hospital - organization & administration; Emergency Service, Hospital - statistics & numerical data; Emergency Service, Hospital - trends; Female; Hospitals, Psychiatric - organization & administration; Hospitals, Psychiatric - statistics & numerical data; Humans; Male; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; psychiatric emergency; psychotic episode; Retrospective Studies; substance use disorder; suicidal behavior; Switzerland; Telemedicine - instrumentation; Telemedicine - methods; Telemedicine - statistics & numerical data; telepsychiatry
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina56060295

Psychiatric disorders constitute frequent causes of emergency department (ED) admissions and these rates are increasing. However, referring to ED a whole range of conditions that could or should be dealt with elsewhere is imposing itself as a problematic situation. We aimed: (1) to provide a descriptive picture of the socio-demographic and diagnostic characteristics of the visits among adults at the psychiatric ED; (2) to estimate the clinical pertinence of these visits. Retrospective analysis of diagnostic/socio-demographic characteristics and clinical trajectories of patients admitted for a psychiatric condition at the adult psychiatric ED of the University Hospital of Geneva (HUG), Switzerland, during a 6-week timespan. In our sample ( = 763 total admissions for psychiatric conditions; = 702 for inclusion of patients having received a medical evaluation), depression/anxiety, suicidal behavior (SB), psychotic episode, and substance use disorder (SUD), in descending order, were the most common diagnoses for referral. Patients belonged to younger age groups (≤65 years), had a familial status other than married/in couple, and did not present an unfavorable socio-demographic profile. Concerning the pertinence for a psychiatric ED, primary diagnosis of depression/anxiety is the only variable significantly associated with different grade of degree. By the examination of the patients' trajectory from admission to discharge, the clinical pertinence for a psychiatric ED admission existed for cases assigned to the Echelle Suisse du Tri (EST ) scale degree 1 (corresponding to most urgent and severe conditions), particularly for diagnoses of depression/anxiety associated with SB, SB as primary or comorbid diagnosis, and psychotic and manic/hypomanic episode. However, diagnoses of depression/anxiety without urgent and severe features (degrees 2, 3, 4) constituted the most frequent mode of presentation. Ambulatory and community-integrated settings could be more appropriate for the majority of patients admitted to adult psychiatric EDs. Moreover, the implementation of telepsychiatry strategies represents a very promising opportunity to offer these patients care continuity, reduce costs and filter the demand for psychiatric ED.