Citation

Reid N, Castel S, Veldhuizen S, Roberts A, Stergiopoulos V. Psychiatr. Serv. 2019; ePub(ePub): appips201900112.

Affiliation

Centre for Addiction and Mental Health, Toronto (Reid, Veldhuizen, Stergiopoulos); Sunnybrook Health Sciences Centre, Toronto (Castel); Department of Psychiatry, University of Toronto, Toronto (Castel, Stergiopoulos); Adair Roberts and Associates, Inc., Toronto (Roberts).

Copyright

(Copyright © 2019, American Psychiatric Association)

DOI

10.1176/appi.ps.201900112

PMID

31357920

Abstract

OBJECTIVE: This study examined recent growth in demand for acute mental health and addiction (MHA) care in a large urban center and changes in patient flow following the expansion of a psychiatric emergency department (ED).

METHODS: A retrospective observational design used administrative data in adjusted negative binomial regression models to identify time trends at seven hospitals over a 6-year period in central Toronto. Two-part linear spline models compared trends before and after a psychiatric ED expansion.

RESULTS: Per capita MHA-related ED visits grew rapidly across the acute care system over the study period, although admissions per MHA ED visit decreased. Expanding a psychiatric ED did not influence overall system-level growth, but it significantly shifted traffic; the annual MHA ED visit growth rate increased at the expanded ED while decreasing at surrounding hospitals.

CONCLUSIONS: Given increasing demand systemwide, individual hospital ED expansions may be inappropriate; planning should consider the whole system.

Language: en

Keywords

Emergency departments; General hospital psychiatry; Mental health hospitals; Mental health systems; Service use trends