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Mental health visits, boarding continue to climb
SAN DIEGO – Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among children and 41% among adults, results from an analysis of national hospital data showed.
According to Dr. Santillanes, an emergency medicine physician at the University of Southern California, Los Angeles, data from older studies and non–nationally representative studies have demonstrated that mental health–related ED visits have been increasing. “Emergency physicians know from experience that mental health–related ED visits are increasing and that patients are boarding in EDs longer, but there had not been recent nationally representative studies analyzing these trends in visits by pediatric and adult patients,” she said.
In an effort to describe recent trends in mental health–related ED visits for patients of different ages, Dr. Santillanes and her colleagues retrospectively analyzed data from the National Hospital Ambulatory Medical Care Survey, which generates nationally representative annual estimates of ambulatory care visits to general, nonfederal, short-stay U.S. hospitals. They calculated the proportion of ED visits during 2009-2015 in which one of the first three discharge diagnoses was a mental health or substance abuse diagnosis as defined by the Healthcare Cost and Utilization Project’s Clinical Classifications Software categorization scheme. They excluded patients diagnosed with developmental disorders, as well as those with a diagnosis of delirium, dementia, amnestic and other cognitive disorders, fetal/newborn complications of alcohol and substance abuse, and chronic medical complications of alcohol abuse. The researchers also calculated ED length of stay (LOS) and the proportion of mental health ED visits resulting in inpatient care in the form of admission, observation, or transfer and used linear regression models to examined time trends of the survey data estimates.
Dr. Santillanes and her associates found that mental health–related ED visits for children jumped from 699,677 visits in 2009 to 1,095,313 visits in 2015, an increase of 56%. Adult mental health–related ED visits rose from 7.1 million in 2009 to 10 million in 2015, an increase of 41%. The researchers also found that encounters with a mental health discharge diagnosis rose from 2.1% of pediatric ED visits in 2009 to 3.4% of visits in 2015 (P = .006). For adults, the proportion of ED visits with a mental health discharge diagnosis rose from 6.9% in 2009 to 9.9% in 2015 (P less than .001). In 2015, more than 10% of visits in patients aged 15-64 years and 8.9% of visits in children aged 10-14 years resulted in a mental health discharge diagnosis visits. During this period, the proportion of ED mental health visits that resulted in inpatient care declined from 29.8% to 20.4%, or an average of –2.3% per year; P = .004). At the same time, ED LOS for patients receiving inpatient care increased from 401 to 528 minutes (a 31.7% increase, or an average of 28.6 minutes per year; P = .006), while ED LOS for discharged patients averaged 259.5 minutes and did not significantly change over the study period (P = .660).
“The mean length of stay for these visits was 8.8 hours in 2015,” Dr. Santillanes said. “That represents more than a 30% increase in length of stay from 2009. When we board patients awaiting admission for other medical conditions, we treat their medical conditions while they wait for an inpatient bed. In most EDs, when patients board awaiting a psychiatric bed, they are not receiving treatment for their psychiatric condition. Besides adding to ED crowding, those prolonged boarding times result in patients who need intensive mental health treatment spending many hours in an ED without treatment for their mental health condition.”
Knowing that patients with mental health disorders represent a significant and increasing portion of the patients treated in our EDs, Dr. Santillanes continued, emergency physicians need to determine how to best treat patients with mental health emergencies. “We have dramatically improved the care we provide to patients with medical and surgical conditions,” she said. “We need to do the same for patients with mental health emergencies. Patients with mental health emergencies represent a large proportion of the patients we treat, so we need to be prepared to provide compassionate and evidence-based care for patients with mental health conditions. At the same time, we also need to continue to advocate for improved access to mental health care for all patients so that [they] do not have to rely on emergency departments to access care.”
The researchers reported having no financial disclosures.
SOURCE: Santillanes G et al. Ann Emerg Med. 2018 Oct. doi. 10.1016/j.annemergmed.2018.08.050.
SAN DIEGO – Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among children and 41% among adults, results from an analysis of national hospital data showed.
According to Dr. Santillanes, an emergency medicine physician at the University of Southern California, Los Angeles, data from older studies and non–nationally representative studies have demonstrated that mental health–related ED visits have been increasing. “Emergency physicians know from experience that mental health–related ED visits are increasing and that patients are boarding in EDs longer, but there had not been recent nationally representative studies analyzing these trends in visits by pediatric and adult patients,” she said.
In an effort to describe recent trends in mental health–related ED visits for patients of different ages, Dr. Santillanes and her colleagues retrospectively analyzed data from the National Hospital Ambulatory Medical Care Survey, which generates nationally representative annual estimates of ambulatory care visits to general, nonfederal, short-stay U.S. hospitals. They calculated the proportion of ED visits during 2009-2015 in which one of the first three discharge diagnoses was a mental health or substance abuse diagnosis as defined by the Healthcare Cost and Utilization Project’s Clinical Classifications Software categorization scheme. They excluded patients diagnosed with developmental disorders, as well as those with a diagnosis of delirium, dementia, amnestic and other cognitive disorders, fetal/newborn complications of alcohol and substance abuse, and chronic medical complications of alcohol abuse. The researchers also calculated ED length of stay (LOS) and the proportion of mental health ED visits resulting in inpatient care in the form of admission, observation, or transfer and used linear regression models to examined time trends of the survey data estimates.
Dr. Santillanes and her associates found that mental health–related ED visits for children jumped from 699,677 visits in 2009 to 1,095,313 visits in 2015, an increase of 56%. Adult mental health–related ED visits rose from 7.1 million in 2009 to 10 million in 2015, an increase of 41%. The researchers also found that encounters with a mental health discharge diagnosis rose from 2.1% of pediatric ED visits in 2009 to 3.4% of visits in 2015 (P = .006). For adults, the proportion of ED visits with a mental health discharge diagnosis rose from 6.9% in 2009 to 9.9% in 2015 (P less than .001). In 2015, more than 10% of visits in patients aged 15-64 years and 8.9% of visits in children aged 10-14 years resulted in a mental health discharge diagnosis visits. During this period, the proportion of ED mental health visits that resulted in inpatient care declined from 29.8% to 20.4%, or an average of –2.3% per year; P = .004). At the same time, ED LOS for patients receiving inpatient care increased from 401 to 528 minutes (a 31.7% increase, or an average of 28.6 minutes per year; P = .006), while ED LOS for discharged patients averaged 259.5 minutes and did not significantly change over the study period (P = .660).
“The mean length of stay for these visits was 8.8 hours in 2015,” Dr. Santillanes said. “That represents more than a 30% increase in length of stay from 2009. When we board patients awaiting admission for other medical conditions, we treat their medical conditions while they wait for an inpatient bed. In most EDs, when patients board awaiting a psychiatric bed, they are not receiving treatment for their psychiatric condition. Besides adding to ED crowding, those prolonged boarding times result in patients who need intensive mental health treatment spending many hours in an ED without treatment for their mental health condition.”
Knowing that patients with mental health disorders represent a significant and increasing portion of the patients treated in our EDs, Dr. Santillanes continued, emergency physicians need to determine how to best treat patients with mental health emergencies. “We have dramatically improved the care we provide to patients with medical and surgical conditions,” she said. “We need to do the same for patients with mental health emergencies. Patients with mental health emergencies represent a large proportion of the patients we treat, so we need to be prepared to provide compassionate and evidence-based care for patients with mental health conditions. At the same time, we also need to continue to advocate for improved access to mental health care for all patients so that [they] do not have to rely on emergency departments to access care.”
The researchers reported having no financial disclosures.
SOURCE: Santillanes G et al. Ann Emerg Med. 2018 Oct. doi. 10.1016/j.annemergmed.2018.08.050.
SAN DIEGO – Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among children and 41% among adults, results from an analysis of national hospital data showed.
According to Dr. Santillanes, an emergency medicine physician at the University of Southern California, Los Angeles, data from older studies and non–nationally representative studies have demonstrated that mental health–related ED visits have been increasing. “Emergency physicians know from experience that mental health–related ED visits are increasing and that patients are boarding in EDs longer, but there had not been recent nationally representative studies analyzing these trends in visits by pediatric and adult patients,” she said.
In an effort to describe recent trends in mental health–related ED visits for patients of different ages, Dr. Santillanes and her colleagues retrospectively analyzed data from the National Hospital Ambulatory Medical Care Survey, which generates nationally representative annual estimates of ambulatory care visits to general, nonfederal, short-stay U.S. hospitals. They calculated the proportion of ED visits during 2009-2015 in which one of the first three discharge diagnoses was a mental health or substance abuse diagnosis as defined by the Healthcare Cost and Utilization Project’s Clinical Classifications Software categorization scheme. They excluded patients diagnosed with developmental disorders, as well as those with a diagnosis of delirium, dementia, amnestic and other cognitive disorders, fetal/newborn complications of alcohol and substance abuse, and chronic medical complications of alcohol abuse. The researchers also calculated ED length of stay (LOS) and the proportion of mental health ED visits resulting in inpatient care in the form of admission, observation, or transfer and used linear regression models to examined time trends of the survey data estimates.
Dr. Santillanes and her associates found that mental health–related ED visits for children jumped from 699,677 visits in 2009 to 1,095,313 visits in 2015, an increase of 56%. Adult mental health–related ED visits rose from 7.1 million in 2009 to 10 million in 2015, an increase of 41%. The researchers also found that encounters with a mental health discharge diagnosis rose from 2.1% of pediatric ED visits in 2009 to 3.4% of visits in 2015 (P = .006). For adults, the proportion of ED visits with a mental health discharge diagnosis rose from 6.9% in 2009 to 9.9% in 2015 (P less than .001). In 2015, more than 10% of visits in patients aged 15-64 years and 8.9% of visits in children aged 10-14 years resulted in a mental health discharge diagnosis visits. During this period, the proportion of ED mental health visits that resulted in inpatient care declined from 29.8% to 20.4%, or an average of –2.3% per year; P = .004). At the same time, ED LOS for patients receiving inpatient care increased from 401 to 528 minutes (a 31.7% increase, or an average of 28.6 minutes per year; P = .006), while ED LOS for discharged patients averaged 259.5 minutes and did not significantly change over the study period (P = .660).
“The mean length of stay for these visits was 8.8 hours in 2015,” Dr. Santillanes said. “That represents more than a 30% increase in length of stay from 2009. When we board patients awaiting admission for other medical conditions, we treat their medical conditions while they wait for an inpatient bed. In most EDs, when patients board awaiting a psychiatric bed, they are not receiving treatment for their psychiatric condition. Besides adding to ED crowding, those prolonged boarding times result in patients who need intensive mental health treatment spending many hours in an ED without treatment for their mental health condition.”
Knowing that patients with mental health disorders represent a significant and increasing portion of the patients treated in our EDs, Dr. Santillanes continued, emergency physicians need to determine how to best treat patients with mental health emergencies. “We have dramatically improved the care we provide to patients with medical and surgical conditions,” she said. “We need to do the same for patients with mental health emergencies. Patients with mental health emergencies represent a large proportion of the patients we treat, so we need to be prepared to provide compassionate and evidence-based care for patients with mental health conditions. At the same time, we also need to continue to advocate for improved access to mental health care for all patients so that [they] do not have to rely on emergency departments to access care.”
The researchers reported having no financial disclosures.
SOURCE: Santillanes G et al. Ann Emerg Med. 2018 Oct. doi. 10.1016/j.annemergmed.2018.08.050.
REPORTING FROM ACEP18
Key clinical point: Mental health ED visits are rising, in total number and as a proportion of all ED visits for children and adults.
Major finding: Between 2009 and 2015, the proportion of children and adults who made mental health–related ED visits increased 56% and 41%, respectively.
Study details: A retrospective analysis of National Hospital Ambulatory Medical Care Survey data between 2009 and 2015.
Disclosures: The researchers reported having no financial disclosures.
Source: Santillanes G et al. Ann Emerg Med. 2018 Oct. doi. 10.1016/j.annemergmed.2018.08.050.
Value-based care news abounds at ACEP18
The answer is none.
The question (for $1,000, Alex) is how many of the dozens of proposals to create physician-focused alternative payment models (APMs) have been approved under the new federal Quality Payment Program?
However, ACEP’s submission, entitled the Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions, seems to have gotten close to a nod when federal health care leaders showed up at a recent meeting on the model.
Reviewers from the Physician-Focused Payment Model Technical Advisory Committee “thought that we met all 10 criteria for models that the secretary put forth for evaluating physician-focused payment models,” Jeffrey Davis, ACEP director of regulatory affairs, said in an interview, adding that the attendance at the meeting of Alex Azar, secretary of Health & Human Serviecs, and Seema Verma, administrator of the Centers for Medicare & Medicaid Services, was a positive development.
To read our full story, check out the link below.
Key sessions at ACEP18 on QPP, MACRA, APMs, and MIPS include:
MO-058 Goodbye SGR! Hello MACRA and MIPS
Monday, Oct. 1 | 1:30 PM
TU-131 FAST FACTS: Reimbursement Topics for the Practicing Emergency Physician
Tuesday, Oct. 2 | 10:00 AM
TU-187 Alternative Payment Models: The New Reimbursement Frontier
Tuesday, Oct. 2 | 4:00 PM
The answer is none.
The question (for $1,000, Alex) is how many of the dozens of proposals to create physician-focused alternative payment models (APMs) have been approved under the new federal Quality Payment Program?
However, ACEP’s submission, entitled the Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions, seems to have gotten close to a nod when federal health care leaders showed up at a recent meeting on the model.
Reviewers from the Physician-Focused Payment Model Technical Advisory Committee “thought that we met all 10 criteria for models that the secretary put forth for evaluating physician-focused payment models,” Jeffrey Davis, ACEP director of regulatory affairs, said in an interview, adding that the attendance at the meeting of Alex Azar, secretary of Health & Human Serviecs, and Seema Verma, administrator of the Centers for Medicare & Medicaid Services, was a positive development.
To read our full story, check out the link below.
Key sessions at ACEP18 on QPP, MACRA, APMs, and MIPS include:
MO-058 Goodbye SGR! Hello MACRA and MIPS
Monday, Oct. 1 | 1:30 PM
TU-131 FAST FACTS: Reimbursement Topics for the Practicing Emergency Physician
Tuesday, Oct. 2 | 10:00 AM
TU-187 Alternative Payment Models: The New Reimbursement Frontier
Tuesday, Oct. 2 | 4:00 PM
The answer is none.
The question (for $1,000, Alex) is how many of the dozens of proposals to create physician-focused alternative payment models (APMs) have been approved under the new federal Quality Payment Program?
However, ACEP’s submission, entitled the Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions, seems to have gotten close to a nod when federal health care leaders showed up at a recent meeting on the model.
Reviewers from the Physician-Focused Payment Model Technical Advisory Committee “thought that we met all 10 criteria for models that the secretary put forth for evaluating physician-focused payment models,” Jeffrey Davis, ACEP director of regulatory affairs, said in an interview, adding that the attendance at the meeting of Alex Azar, secretary of Health & Human Serviecs, and Seema Verma, administrator of the Centers for Medicare & Medicaid Services, was a positive development.
To read our full story, check out the link below.
Key sessions at ACEP18 on QPP, MACRA, APMs, and MIPS include:
MO-058 Goodbye SGR! Hello MACRA and MIPS
Monday, Oct. 1 | 1:30 PM
TU-131 FAST FACTS: Reimbursement Topics for the Practicing Emergency Physician
Tuesday, Oct. 2 | 10:00 AM
TU-187 Alternative Payment Models: The New Reimbursement Frontier
Tuesday, Oct. 2 | 4:00 PM
REPORTING FROM ACEP18
Meeting preview: Mental health ED visits spiked between 2009 and 2015
Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among pediatric patients and 41% among adults, according to data that will be presented at the annual meeting of the American College of Emergency Physicians.
“The current mental health system is in crisis and the impact on emergency departments continues to increase,” lead researcher Genevieve Santillanes, MD, said in an interview in advance of the meeting. “We are seeing more patients with mental health disorders and when patients with mental health disorders require inpatient care, they board in the ED for long periods of time.”
Look to our onsite meeting coverage October 1-4 for additional details on this study and more news from ACEP18!
Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among pediatric patients and 41% among adults, according to data that will be presented at the annual meeting of the American College of Emergency Physicians.
“The current mental health system is in crisis and the impact on emergency departments continues to increase,” lead researcher Genevieve Santillanes, MD, said in an interview in advance of the meeting. “We are seeing more patients with mental health disorders and when patients with mental health disorders require inpatient care, they board in the ED for long periods of time.”
Look to our onsite meeting coverage October 1-4 for additional details on this study and more news from ACEP18!
Between 2009 and 2015, the number of emergency department visits related to mental health increased 56% among pediatric patients and 41% among adults, according to data that will be presented at the annual meeting of the American College of Emergency Physicians.
“The current mental health system is in crisis and the impact on emergency departments continues to increase,” lead researcher Genevieve Santillanes, MD, said in an interview in advance of the meeting. “We are seeing more patients with mental health disorders and when patients with mental health disorders require inpatient care, they board in the ED for long periods of time.”
Look to our onsite meeting coverage October 1-4 for additional details on this study and more news from ACEP18!
REPORTING FROM ACEP18
ACEP18: Toxicology updates & emerging trends
The dangers of synthetic drugs and heroin, and the opioid epidemic, are hitting emergency departments hard. A lack of guidelines and poor presentation to follow-up care make treatment decisions difficult. Pockets of outbreaks emerge when dangerous toxins are added to already dangerous drugs. One such regional outbreak occurred in March 2018 when synthetic cannabinoids laced with superwarfarin were led to 150 patients presenting to hospitals with severe coagulopathy in Illinois.
ACEP18 will feature a plethora of toxicology presentations and workshops, such as “Emergency Toxicology: Emerging Trends – Cases in Poisoning Management” on Tuesday, Oct. 2 at 8 am, led my Patrick M. Lank, MD, FACEP. Dr. Lark, an emergency medicine specialist in Chicago, will also be leading “Critical Update in Toxicology 2018" on Monday, Oct. 1, at 12:30 pm and “FAST FACTS: High-Yield Toxicology,” on Monday, at 4:30 pm.
The dangers of synthetic drugs and heroin, and the opioid epidemic, are hitting emergency departments hard. A lack of guidelines and poor presentation to follow-up care make treatment decisions difficult. Pockets of outbreaks emerge when dangerous toxins are added to already dangerous drugs. One such regional outbreak occurred in March 2018 when synthetic cannabinoids laced with superwarfarin were led to 150 patients presenting to hospitals with severe coagulopathy in Illinois.
ACEP18 will feature a plethora of toxicology presentations and workshops, such as “Emergency Toxicology: Emerging Trends – Cases in Poisoning Management” on Tuesday, Oct. 2 at 8 am, led my Patrick M. Lank, MD, FACEP. Dr. Lark, an emergency medicine specialist in Chicago, will also be leading “Critical Update in Toxicology 2018" on Monday, Oct. 1, at 12:30 pm and “FAST FACTS: High-Yield Toxicology,” on Monday, at 4:30 pm.
The dangers of synthetic drugs and heroin, and the opioid epidemic, are hitting emergency departments hard. A lack of guidelines and poor presentation to follow-up care make treatment decisions difficult. Pockets of outbreaks emerge when dangerous toxins are added to already dangerous drugs. One such regional outbreak occurred in March 2018 when synthetic cannabinoids laced with superwarfarin were led to 150 patients presenting to hospitals with severe coagulopathy in Illinois.
ACEP18 will feature a plethora of toxicology presentations and workshops, such as “Emergency Toxicology: Emerging Trends – Cases in Poisoning Management” on Tuesday, Oct. 2 at 8 am, led my Patrick M. Lank, MD, FACEP. Dr. Lark, an emergency medicine specialist in Chicago, will also be leading “Critical Update in Toxicology 2018" on Monday, Oct. 1, at 12:30 pm and “FAST FACTS: High-Yield Toxicology,” on Monday, at 4:30 pm.
REPORTING FROM ACEP18