Nursing Notes

October 17, 2011

EDs seeing more children for psychiatric care

Here is an article from Nurse.com that presents the findings of a study showing that mentally ill patients, and in particular, mentally ill children are being forced by cutbacks in mental healthcare to utilize the emergency rooms more and more in order to get the help they need.

Emergency rooms are already overcrowded and when you add in mentally ill patients that come to the ER because they cannot get seen in any outpatient clinic, you have a disaster.  People believe that the ER is the magic answer to their health problems when in reality this system is stretched so far that real emergencies have trouble getting care sometimes.

We all know that going to the emergency room with a non-life-threatening problem means a very, very long wait.  Triage will put you to the end of the line and let the life-threatening problems have first opening.  That is really the way it is supposed to work.  However, it seems that with a population woefully under or non-insured, the ER becomes the place of last resort.  There has to be a solution to this problem.  There just has to be.  ER nurses are burning out at record numbers.

Please visit the Nurse.com site and read other articles similar to this one and be sure to leave them a comment.

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Pediatric patients, primarily those who are underinsured, are increasingly receiving psychiatric care in EDs, according to an abstract presented Oct. 14 at the American Academy of Pediatrics National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status and type of care received, from the National Hospital Ambulatory Medical Care Survey between 1999 and 2007. They found during eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8% were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4% in 1999 to 3% in 2007. The underinsured group — patients without insurance or who are on Medicaid — initially accounted for 46% of pediatric ED visits in 1999 and grew to 54% in 2007.

The data show, as anticipated, psychiatric visits by children to EDs continue to increase in number and as a percentage of all patients being seen in EDs, said lead study author Zachary Pittsenbarger, MD, of Children’s Hospital Boston.

“A second, and more novel finding, is that one group in particular is increasing beyond any other sociodemographic group, and that is the publicly insured,” he said. “It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized. This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”


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