Effectiveness of a 24-Hour Crisis Unit in Stabilization of Psychiatric Patient's Disposition and Return Rates

Introduction: The primary objective of this study is to determine if the crisis intervention (CSU) at an urban 24-hour Crisis Stabilization Unit (CSU) is effective in stabilization of psychiatric patient’s acute symptoms and avoidance of boarding and psychiatric hospitalization.

Method: A retrospective random sample chart review of all psychiatric patients who receive a medical clearance from Emergency Department (ED) who were sent to an urban 24-hour CSU will be included in the study. The determination of boarding for each patient will be done by finding the difference in time from initial ED and CSU. Each patient will be tracked to determine whether they were discharged or admitted to inpatient psychiatric services. Examine outcomes as they relate to inpatient hospitalizations, return time to CSU or inpatient, cost for psychiatric related illness. Additional demographic information will also be collected; such as age, type of mental illness, ED triage rating, payment method, diagnosis, and treatment (inpatient and outpatient). The information will be analyzed using SPSS 22.0 for statistical analysis. This study was IRB approved.

Results: A total of 200 patients were included in the study. A portion of patients 34% (69) were sent home with self care instructions after their stay in PES. However, 65% (131) of the patients, were admitted to psychiatric units after their stay in CSU. There was a no significant difference in return visit to the ED for patients who were in CSU and then sent home as compared to those who were admitted for inpatient. However that is only true for the 30 day period. Of the patients initially treated by CSU but were sent home only 11% (18) came back to the ED in 30 days. Patients initially treated by CSU for psychiatric illness who were admitted back into inpatient after 30 days at 16% (22). Those who were admitted came back in 90 days at 48% (63) as compared to those who were sent home who overwhelmingly came back at 96% (67) within the same 90 day period.

Conclusions: The impact of PES of non boarding or admitting psychiatric patients was seen for a third of the patients who went to it. There was however, no significant difference in admitted or non admitted patient’s with regards to their 30 day returning rate to the ED. Both of these groups of patients had a lower return rate at 30 days after their time in CSU. Those patients who did not get admitted from the PES unit however, were more likely to return after 90 days than those who were admitted from the CSU unit. This could be an indication that PES has a limited impact on those patients who are not admitted.