Predictors of Psychiatric Length of Stay and Emergency Room Department Utilization

Objective: The purpose of this study was two fold: (1) to examine predictors of length of stay (LOS) of patients with a psychiatric diagnosis admitted through the emergency department (ED); (2) to examine factors associated with having the ED as point of entry for psychiatric admissions.

Methodology: This is a retrospective cohort study of data from the Virginia Health Information Incorporated. A secondary analysis was conducted by the researchers to identify and examine 2006 data of all patients admitted into Virginia hospitals through the ED with a Major Diagnostic Categories (MDC) of 19 (psychiatric). Bivariate tests determined associations between LOS and age, ethnicity, gender, insurance type and ED admission status. Multiple linear and logistic regression models assessed independent effects on LOS.

Results: 56% of the patients were female, with a mean age of 40.61 (s.d. 19.864). The strongest predictor of length of stay for psychiatric patients admitted through the ED was ED admission status. Other factors that are positively associated with LOS are age, gender, insurance type and those identified as non-white. The most significant predictor in admission rate of psychiatric patients was self-pay with an unadjusted beta of .124 (p < .000). Other predictors included gender, non-white and medical hospital procedure.

Conclusion: A substantial portion of variance in LOS is due to socio-demographic variables and payment type; however, only the overall model was significant. Findings suggest the need to further investigate alternative treatment options such as crisis stabilization units for patients suffering with mental illness.