Evaluation of a Cost-Effective Alternative to Inpatient Psychiatric Admissions via Emergency Departments

Dennis Bittner, PhD

The study presented at APA was in response to emergency department overcrowding.

atients seeking emergency department (ED) care for urgent psychiatric symptoms has incre

ased dramatically in North America

since 2006

, Neeraj Bajaj, MD,

Kingston Health Sciences Centre,

Queens University, Kingston, ON, Canada, told an audience at the annual APA meeting in San Diego.

The number of p

The dramatic increase can lead to increased wait times and overcrowding in the ED, along with issues particularly affecting those seeking psychiatric treatment, Bajaj said.

L

ack of urgent psychiatric services

(UPS)

can

also

lead to ED reci

divism, resulting in high

healthcare costs

and accounting for

one-third of all ED visits for psyc

hiatric complaints,” Bajaj said. “Further,

inadequate psychiatric and transitional services may lead to

prolonged or

unnecessary inpatient psychiatric admissions

, creating additional healthcare costs

.

when

UPS

is available, it

can

provide timely access to ambulatory psychiatric care

, offering

the potential

of reducing avoidable

acute care use

and re

admissions

.

Bajaj said that

UPS

is a means of

deliver

ing

transitional care for patients followi

ng discharge from an inpatient

admission

,” Bajaj said.

coping reviews

in the literature

had demonstrated

a gap

on how

best to develop UPS

, Bajaj’s group

develop

ed

their own

program addressing the

se

issue

s

,

Intensive Transitional Treatment Program (ITTP)

.

Because s named the

The ITTP is a newly-implemented model for UPS at Kingston Health Sciences Centre, Bajaj said. It offers psychotherapy groups and services to psychiatric patients in a multi-disciplinary framework over 4 weeks.

Thus far, the program has been well received by patients.

Analysis of anonymized feedback from patients attending ITTP was very positive among participants, with all participants surveyed recommending the program to others,”

Bajaj said.

Bajaj’s group evaluated the ITTP in a

non-randomized

,

pre-

and post-intervention study

of psychiatric inpatient admissions, readmissions, and length of stay

(LOS)

for nearly 2000

patients admitted to adult psychiatry at Kingston H

ealth Sciences Centre

in the 12 months

before and after implementation of ITTP.

a resident at Kingston

who also participated in the evaluation, delivered details of its results.

Jonathan Fairbairn, MD,

A significant decrease in occupied beds on the adult psychiatric unit was observed in the 24-mont

h

period after implementation of ITTP

”, Fairbairn

said.

“In addition,

admissions to adult psychiatry via the ED were

reduced from 998 to

864

in the 12 months after ITTP compared

with the previous 12 months. “

Fairbairn added there was a “significant decrease” in median LOS from 10 days to just 8 in the adult inpatient psychiatric unit, as well as a drop in patient readmissions during the 2nd observed year of the ITTP program adult psychiatric unit.

e ITTP model for psychiatric services

developed at Kingston was able to

bridge the gap between” deficient community psychiatric services and expensive

overburdened inpatient services.”

Thus, the model can serve

patient admission, as well as facilitating

transition

s

from inpatient to outpatient treatment settings.

Fairbairn said that th as an effective alternative to in

readmission, and LOS

on the adult psychiatric inpatient unit at Kinston Health Sciences Center.

Concluding the presentation, Fairbairn said the ITTP contributed to decreased rates in psychiatric admission,

ce of the effectiveness of

an urgent psychiatric model that provides an alternative to psychiatric hospitalization

,” Fairbairn said. “Importantly, participating patients

viewed ITTP as a positive therapeutic intervention.

“This study provides eviden