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Review of Psychiatric Patient Transfer Times in an Emergency Department with Limited Psychiatric Services

Published online by Cambridge University Press:  13 July 2023

Maria Conradie
Affiliation:
Wexford General Hospital, Wexford, Ireland
Brendan Orsmond
Affiliation:
Wexford General Hospital, Wexford, Ireland
Robin Andrews
Affiliation:
Wexford General Hospital, Wexford, Ireland
Muhammad Bilal
Affiliation:
Wexford General Hospital, Wexford, Ireland
Andrea van der Vegte
Affiliation:
Wexford General Hospital, Wexford, Ireland University of South Wales, Cardiff, United Kingdom
Ria Abraham
Affiliation:
Wexford General Hospital, Wexford, Ireland
Rochelle Janse van Rensburg
Affiliation:
Wexford General Hospital, Wexford, Ireland
Syed Taqvi
Affiliation:
Wexford General Hospital, Wexford, Ireland
Phillip Jordaan
Affiliation:
Wexford General Hospital, Wexford, Ireland
Marco Smit
Affiliation:
Wexford General Hospital, Wexford, Ireland
Ashleigh Dowle
Affiliation:
Wexford General Hospital, Wexford, Ireland
Darshini Vythilingam
Affiliation:
Wexford General Hospital, Wexford, Ireland
Bryce Wickham
Affiliation:
Wexford General Hospital, Wexford, Ireland
Keith Kennedy
Affiliation:
Wexford General Hospital, Wexford, Ireland
Thomas Kelly
Affiliation:
Wexford General Hospital, Wexford, Ireland
Michael Molloy
Affiliation:
Wexford General Hospital, Wexford, Ireland School of Medicine, UCD, Dublin, Ireland Beth Israel Deaconess Medical Centre Fellowship in Disaster Medicine, Boston, USA
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Abstract

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Introduction:

The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.

Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.

Method:

Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.

Results:

The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.

Conclusion:

There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.

Type
Tabletop Presentations
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine