36 - An overview and implications of the pediatric psychiatric population seen in the Critical Access Emergency Department Setting

Poster Number: 36
Publication Number: 36.103

Martha (Molly) W. Stevens, Larner School of Medicine, UVM, Division of Emergency Medicine, Burlington, VT, United States; Mary D. Patterson, University of Florida College of Medicine, Gainesville, FL, United States; Marc Auerbach, Yale School of Medicine, Milford, CT, United States; William A. Mills, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Jessica Katznelson, Johns Hopkins School of Medicine, Baltimore, MD, United States

Background: The number of pediatric psychiatric patients seen in Emergency Departments (ED) over the past decade has increased exponentially. At urban academic centers, these patients are often triaged at a high acuity level and require complex care, stressing the resources of even large pediatric ED.

Critical Access Hospital (CAH) are small rural institutions that provide the only source of ED care to children in their catchment areas. While there is much data on pediatric psychiatric patients in urban ED, there is far less in the rural setting. There is no good description in the literature of the pediatric psychiatric population seen in CAH; thereby, hampering the development of resources and programs to support these patients and the ED that care for them

Objective: To describe the demographics, presentation and disposition of pediatric psychiatric patients treated in the CAH ED setting.

Design/Methods: We reviewed the electronic medical record of all patients under the age of 18 presenting to 3 CAH over a 1 year period. Data was abstracted on age, gender, chief complaint, triage acuity,,final diagnosis and disposition. Psychiatric v non psychiatric patients were compared using percentages.

Results: 3441 unique children were seen in the ED over the study period. 103 (3%) were for psychiatric complaints. Psychiatric patients were older (mean age 14 v 7) and evenly split male v female. 70% of psychiatric patients were triaged as level 2 (scale of 1-5) compared to only 1.2% of non-psychiatric patients. (p < 0.01) Psychiatric patients accounted for 38% of these high acuity patients. 51% of psychiatric patients were discharged from the ED as opposed to 97% of non psychiatric patients (p < 0.01) and of the 49% admitted, 98% required transfer to another institution. Psychiatric conditions accounted for 1/3 of the total transfers. The most common final diagnosis was suicidal ideation, with mental health evaluation and depression being the next most common.Conclusion(s): Psychiatric patients represent a small percentage of the pediatric population seen in CAH ED, but a large proportion of the high acuity patients and those needing transfer to a higher level of care. As in urban environments, there is a pediatric psychiatric crisis in rural ED. Innovative programs, utilizing telemedicine and additional staff training, are needed to provide care to this population while reducing stress on ED resources. The limited resources in this environment must be taken into account when designing these programs. Mobile crisis mental health teams could serve as a way to keep patients out of the ED.