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