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

MAY 23, 2017
Dennis Bittner, PhD
The number of patients seeking emergency department (ED) care for urgent psychiatric symptoms has increased 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 dramatic increase can lead to increased wait times and overcrowding in the ED, along with issues particularly affecting those seeking psychiatric treatment, Bajaj said.
Lack of urgent psychiatric services (UPS) can also lead to ED recidivism, resulting in high healthcare costs and accounting for one-third of all ED visits for psychiatric complaints,” Bajaj said. “Further, inadequate psychiatric and transitional services may lead to prolonged or unnecessary inpatient psychiatric admissions, creating additional healthcare costs. 
Bajaj said that when UPS is available, it can provide timely access to ambulatory psychiatric care, offering the potential of reducing avoidable acute care use and readmissions. 
UPS is a means of delivering transitional care for patients following discharge from an inpatient admission,” Bajaj said. 
Because scoping reviews in the literature had demonstrated a gap on how best to develop UPS, Bajaj’s group developed their own program addressing these issues, named the Intensive Transitional Treatment Program (ITTP). 
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 Health Sciences Centre in the 12 months before and after implementation of ITTP. 
Jonathan Fairbairn, MD, a resident at Kingston who also participated in the evaluation, delivered details of its results.
A significant decrease in occupied beds on the adult psychiatric unit was observed in the 24-month 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.
Fairbairn said that the 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 as an effective alternative to inpatient admission, as well as facilitating transitions from inpatient to outpatient treatment settings. 
Concluding the presentation, Fairbairn said the ITTP contributed to decreased rates in psychiatric admission, readmission, and LOS on the adult psychiatric inpatient unit at Kinston Health Sciences Center.
“This study provides evidence 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.

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