264060 Factors associated with length of stay in a Los Angeles County psychiatric emergency room

Tuesday, October 30, 2012 : 1:30 PM - 1:50 PM

Kristen Ochoa, MD, MPH , Department of Psychiatry, Olive View-UCLA Medical Center/UCLA David Geffen School of Medicine, Sylmar, CA
Ashkan Moazzez, MD , H. Claude Hudson Comprehensive Health Center, Los Angeles, CA
Poonum Chaturvedi, MD, MPH , Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, CA
Alex Kopelowicz, MD , Department of Psychiatry, Olive View-UCLA Medical Center/UCLA David Geffen School of Medicine, Sylmar, CA
Background: Olive View-UCLA Medical Center operates one of three Los Angeles County psychiatric emergency rooms (PER), where overcrowding is an ongoing challenge. We examined factors associated with prolonged stays in our facility. Methods: A total of 427 questionnaires were distributed to clinicians over a 30-day period for patients admitted involuntarily into the PER; 348 were completed (82%). Results: There were 221 males (63.5%). Mean±S.D. age was 34.5±15.5 years. Median length of stay was 26 hours (range: 2-118). While 49.4% of patients were uninsured, 38.8% had public insurance and 11.8% had private insurance. Overall, 77% were admitted to an inpatient psychiatric unit while 23% were discharged. The insured were far more likely to be admitted to an inpatient unit than the uninsured (OR 5.07, 95% CI 2.85–9.04). Active treatment at a County mental health clinic (p=0.666), diagnosis (p=0.599) and immigration status (p=0.678) were not correlated with length of stay. In a bivariate analysis, factors associated with increased length of stay were not having public or private insurance (p=0.000), being homeless (p=0.000), arrival on a weekend (p=0.010), criminal history (p=0.021) and a history of drug and/or alcohol abuse (p=0.036). In a multiple linear regression model, factors associated with an increased length of stay were having no insurance (p=0.000) and being homeless (p=0.007). Conclusions: PER overcrowding due to prolonged stays could be relieved with more inpatient beds for the uninsured, and more housing options for the homeless. Homeless patients may benefit from case managers assigned early in their stay.

Learning Areas:
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public

Learning Objectives:
-Describe factors leading to prolonged stays in a Los Angeles County Hospital psychiatric emergency room. -Formulate potential solutions to psychiatric emergency room overcrowding based upon patient characteristics and other factors associated with increased length of stay.

Keywords: Mental Health Services, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was formerly a field coordinator and co-investigator on a NIDA-funded study. I have published in AJPH and have been an author on five abstracts previously presented at APHA meetings. I have worked as a medical student, resident and attending physician at all three L.A. County psychiatric emergency rooms and am interested multidisciplinary care approaches, utilization and resource management.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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