Psychiatric patients not ‘down-triaged’ in the ED

By Eleanor McDermid, Senior medwireNews Reporter

Study findings refute the belief that patients with psychiatric illness may wait longer than is appropriate to see a doctor in the emergency department (ED).

The research shows that, at least in Ontario, Canada, emergency nurses gave slightly higher priority triage scores to patients with than without psychiatric conditions, giving 27% and 14%, respectively, a score of 1-2.

Overall, 51,381 psychiatric patients who presented to 155 Ontario EDs waited a median of 82 minutes to see a physician, whereas 3,551,413 other patients waited a median of 75 minutes, which was significantly shorter.

The longer wait was significant for periods in which the EDs were not crowded (defined by median overall length of ED stay of 0-3 h), with psychiatric patients waiting 10 minutes longer than other patients, after accounting for confounders including age, gender, triage score, mode of arrival at the ED, and ED crowding.

"However, upon closer inspection, it was only patients in the highest priority triage group who waited longer than other high priority patients when the department was not crowded," comment Clare Atzema (Institute for Clinical Evaluative Science, Toronto, Ontario, Canada) and colleagues.

They say that this difference could be justified by the prioritization of patients receiving time-sensitive therapies, such as myocardial infarction and stroke patients.

Conversely, as crowding increased the wait to see a physician was reduced for psychiatric versus other patients, by 14 minutes during mild crowding (3-6-h median ED stay), 38 minutes during moderate crowding (6-9 h), and 48 minutes during severe crowding (>9 h).

"This effect may be partly explained by the presence of dedicated psychiatric teams in some emergency departments," the researchers write in the Canadian Medical Association Journal.

There was a similar effect for time to a decision to admit, with psychiatric patients having a 5 minute reduced delay, relative to other patients, when the ED was not crowded, a 59-minute reduction during periods of mild crowding, and 128- and 106-minute reductions during periods of moderate and severe crowding, respectively.

At all times, psychiatric patients had a significantly reduced wait between the decision to admit and transfer to a ward, relative to other patients, at 74 versus 152 minutes. Atzema et al suggest that this could be partly due to the availability of "protected" hospital beds for psychiatric patients.

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