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Emergency physicians say psych patients wait too long for care

A group representing emergency physicians said Monday that hospital emergency departments routinely are clogged with patients who are waiting, sometimes for days, for inpatient psychiatric care.

A group representing emergency physicians said Monday that hospital emergency departments routinely are clogged with patients who are waiting, sometimes for days, for inpatient psychiatric care.

The American College of Emergency Physicians (ACEP) bolstered its case with data from a poll of more than 1,700 emergency physicians as well as research presented at its annual meeting this week in Las Vegas.

Like their counterparts in other states, many doctors surveyed in New Jersey and Pennsylvania said the situation had worsened in the last year. Nationally, about half of emergency physicians said mental health care in their communities was worse this year than last. That percentage was 49 percent in Pennsylvania and 38 percent in New Jersey.

Physicians who spoke at a teleconference Monday blamed the situation on inadequate inpatient and outpatient resources for patients with serious mental illnesses. The United States has closed thousands of psychiatric beds since 1970, they said, without doing enough to bolster other types of care.

"The emergency department has become a dumping ground for these patients who have been abandoned by every other part of the health care system," said Rebecca Parker, a Chicago emergency physician and president of ACEP.

Not only does the backlog delay badly needed care for psychiatric patients, the doctors said, but it makes it more difficult to treat other patients as well.

Twenty-one percent of doctors who responded to the national survey said they have patients waiting two to five days for inpatient beds.

The other studies found longer wait times and more transfers for psychiatric patients than for those with "medical" problems.

Renee Hsia, an emergency medicine physician at the University of California, San Francisco, studied whether psychiatric patients were disproportionately responsible for emergency department overcrowding between 2002 and 2011. She found that waiting times were similar for psychiatric and medical patients who were admitted to the hospital, but that psychiatric patients were six times more likely to be transferred. When transfers were required, psychiatric patients waited 312 minutes, compared with 195 for other patients. She also found that psychiatric visits increased faster than nonpsychiatric visits during the study period.

Jane Zhu, a National Clinician Scholar at the University of Pennsylvania's Perelman School of Medicine, was part of Hsia's team.

Suzanne Lippert, an emergency physician at Stanford Medicine, led two studies that looked at the same national data set from 2001 to 2011.

She said she decided to do the study after a severely depressed patient in her 60s spent more than six days in her emergency department. "I hope you can imagine what that must be like if you have depression," she told reporters.

Her team found 65 million visits for psychiatric reasons, including substance abuse. That was 6 percent of all emergency department visits.

One study concluded that substance abuse accounted for 41 percent of psychiatric visits, with depression at 23 percent and anxiety at 26 percent. The majority of patients with serious illnesses such as psychosis and bipolar disorder were either admitted or transferred. They were more likely than other patients to spend more than a day in the ER.

The other study found that 21 percent of all psychiatric patients required admission and 11 percent were transferred. That compares with 13.5 percent and 1.4 percent, respectively, for other patients. Among psychiatric patients, 1.3 percent spent more than a day in the emergency department, while only 0.5 percent of medical patients were there that long. On average, psych patients spent about an hour longer in the emergency department than other patients.

The researchers concluded that, for the sickest patients, the data "demonstrates unacceptable conditions, in which patients are held and do not receive essential psychiatric care."

Asked what would make things better, Parker said, "Comprehensive mental health reform is what we need and we need it now."

215-854-4944 @StaceyABurling