Innovative pathway for managing children and adolescents with mental health concerns in the emergency department: An intervention feasibility study.
adolescent
child
clinical pathway
emergency
mental health problem
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
12
05
2020
accepted:
06
08
2020
pubmed:
5
10
2020
medline:
2
10
2021
entrez:
4
10
2020
Statut:
ppublish
Résumé
To investigate if an innovative clinical pathway for managing child and adolescent mental health (MH) ED presentations reduces average length of stay (LOS) and improves carer satisfaction. An intervention feasibility study at an ED. Participants were 5-17 years olds presenting with MH problems and their carers. ED medical officer (MO) led Kids Assessment Liaison for Mental Health (KALM) clinical pathway was implemented as an intervention and it was compared to Care as Usual pathway which involved ED MO and MH clinicians. Data were collected via the ED clinical data system and a carer survey. Data were analysed by using SAS v9.4 (SAS, Cary, NC, USA). Survey was compared using Fisher's exact test and LOS was compared using median quantile regression. Fifty (23%) patients used the KALM pathway and 169 (77%) the Care as Usual pathway. The median (min, max) LOS in hours for those on the KALM pathway was 4.13 (0.46, 11.55) compared to 5.09 (0.21, 19.12) for Care as Usual pathway (P = 0.1407). Fewer patients breached the National Emergency Access Target (NEAT) when the KALM pathway was used (56%, n = 28 vs 64%, n = 108, P = 0.252). There were no significant differences in the carer survey between the two care pathways. This study provides valuable information about the benefits of the KALM pathway in managing child and adolescent MH presentations to ED. This new pathway reduces the LOS in ED and improves carer experience compared to the usual care pathway.
Identifiants
pubmed: 33012102
doi: 10.1111/1742-6723.13616
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
279-285Informations de copyright
© 2020 Australasian College for Emergency Medicine.
Références
Jenkins B, Katz I. Adolescents' and Young Adults' Use of Emergency Departments: An Evidence Check rapid review brokered by the SAX Institute for the NSW Kids and Families. [Uploaded May 2015, cited 2 Feb 2019.] Available from URL: https://www.saxinstitute.org.au/wp-content/uploads/Adolescents-and-young-adults-use-of-emergency-departments.pdf
Chun T, Duffy S, Linakis J. Emergency department screening for adolescent mental health disorders: the who, what, when, where, why and how it could and should be done. Clin. Pediatr. Emerg. Med. 2013; 14: 3-11.
Benarous X, Milhiet V, Oppetit A et al. Changes in the use of emergency care for the youth with mental health problems over decades: a repeated cross sectional study. Front. Psych. 2019; 10: 26.
Mapelli E, Black T, Doan Q. Trends in pediatric emergency department utilisation for mental health-related visits. J. Pediatr. 2015; 167: 905-10.
Making the most out of crisis: child and adolescent mental health in the emergency department. Lancet 2016; 388: 935.
Hiscock H, Neely R, Lei S, Freed G. Paediatric mental and physical health presentations to emergency departments, Victoria, 2008-15. Med. J. Aust. 2018; 8: 343-8.
Perera J, Wand T, Bein K et al. Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010-2014. Med. J. Aust. 2018; 208: 348-53.
NSW Ministry of Health. NSW State Health Plan Towards 2021. 2014. [Cited 2 Feb 2019.] Available from URL: ttps://www.health.nsw.gov.au/statehealthplan/Pages/NSW-state-health-plan-towards-2021.aspx
Australasian College for Emergency Medicine. The Long Wait: An Analysis of Mental Health Presentations to Australian Emergency Departments. Melbourne: ACEM, 2018.
Australasian College for Emergency Medicine. Policy on the Australasian Triage Rating Scale. 2013. [Cited 2 Feb 2019.] Available from URL: https://acem.org.au/Content-sources/AdvancingEmergency-Medicine-Better-Health-Outcomes-for-Patients/Triage
Sawyer S, Patton G. Why are so many more adolescents presenting to our emergency departments with mental health problems? Med. J. Aust. 2018; 8: 339-40.
Torio C, Encinosa W, Berdahl T, McCormick M, Simpson L. Annual report on health care for children and youth in the United States: national estimates of cost, utilisation and expenditures for children with mental health conditions. Acad. Pediatr. 2015; 15: 19-35.
Naylor C, Das P, Ross S, Honeyman M, Thompson J, Gilburt H. Bringing Together Physical and Mental Health: A New Frontier for Integrated Care. 2016. [Cited 2 Feb 2019.] Available from URL: www.kingsfund.org.uk/publications/physical-and-mental-health
Dolan M, Fein J. The committee on pediatric emergency medicine (2011) technical report-pediatric and adolescent mental health emergencies in the emergency medical services system. Pediatrics 2011; 127: e1356-66.
NSW Ministry of Health. NSW Strategic Framework and Workforce Plan for Mental Health 2018-2022: A Framework and Workforce Plan for NSW Health Services. Sydney: NSW Ministry of Health, 2018.
Australian Bureau of Statistics. Census of Population and Housing, 2016, Table Builder. 2016. [Cited 13 Sep 2019.] Available from URL: https://www.abs.gov.au/websitedbs/censushome.nsf/home/tablebuilder?opendocument&navpos=240
Agency for Clinical Innovation. Kids Acute Liaison in Mental Health. 2014. [Cited 15 Aug 2019.] Available from URL: https://www.aci.health.nsw.gov.au/innovation-exchange/projects/kalm
Goldenring J, Cohen E. Getting into adolescents heads. Contemp. Pediatr. 1988; 7: 75-90.
Klein D, Goldenring J, Adelman W. HEEADSSS 3.0 the psychosocial interview for adolescents updated for a new century fuelled by media. Contemp. Pediatr. 2014; 31: 16-20-22-28.
Cappelli M, Zemek R, Polihronis C et al. The HEADS-ED: evaluating the clinical use of a brief, action-oriented, pediatric mental health screening tool. Pediatr. Emerg. Care 2020; 36: 9-15.
Queensland Health, eds. Guide to Health Service Planning (version 3). 2015. [Cited 1 Nov 2019.] Available from URL: https://www.health.qld.gov.au/__data/assets/pdf_file/0025/443572/guideline-health-service-planning.pdf
Xie Z, Or C. Associations between waiting times, service times, and patient satisfaction in an endocrinology outpatient department: a time study and questionnaire survey. Inquiry 2017; 54: 46958017739527.
Romeo M, May C. Emergency Department Models of Care Review. 2018. [Cited 1 Nov 2019.] Available from URL: https://clinicalexcellence.qld.gov.au/sites/default/files/docs/reviews/ed-models-of-care-review-2018.pdf