Emergency Physicians See More Mental Health Patients Waiting for Beds

A poll of emergency department (ED) physicians finds that more report seeing mental health patients waiting for psychiatric placement, and 21% say patients wait 2 to 5 days for an inpatient bed.

The poll by the American College of Emergency Physicians (ACEP) found that 52% of ED doctors said that the mental health system where they practice has become worse in the past year.

“Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need,” said Rebecca Parker, MD, FACEP, the president of ACEP. “It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the health care system."

The findings were reported at ACEP16, which is holding its Scientific Assembly in Las Vegas, Nevada. Other findings of the poll include:

• About half (48%) of respondents said psychiatric patients are “boarded,” meaning housed in the ED waiting area, at least once a day.
• More than half (57%) reported increased wait times in the ED for children with psychiatric illnesses.
• Just 16.9% said they had a psychiatrist on call to respond to psychiatric emergencies, and more than 11% said they had no one on call to respond to such emergencies.
• More than 10% said they had 6 to 10 patients waiting for inpatient psychiatric beds on their last shift.

Patients with a psychiatric diagnosis are more likely to require admission to the hospital—21% need admission vs 13.5% of medical patients. Patients with psychiatric illnesses, such as bipolar disorder, depression, or dual diagnosis, were far more likely to end up in the ED for more than a 24-hour period, according to research presented at the meeting.

The phenomenon of a loss of psychiatric beds and an increase of psychiatric visits to the ED accounts for the long wait times for patients who need to be admitted to psychiatric care. Psychiatric patients usually wait significantly longer in the ED compared with medical patients, said lead author Suzanne Catherine Lippert, MD, MS, FACEP, of Stanford University.

"In a time of decreased psychiatric inpatient beds and variable access to outpatient psychiatric centers, we are looking at a potential crisis of unmet psychiatric need," she said. "Clinical outcomes for psychiatric patients subjected to prolonged emergency department lengths of stay must be examined alongside the impact of these stays on emergency department crowding."