Presenter Status

Fellow

Abstract Type

Research

Primary Mentor

Shobhit Jain, MD

Start Date

2-5-2022 11:30 AM

End Date

2-5-2022 1:30 PM

Presentation Type

Poster Presentation

Description

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at a quaternary children’s hospital ED with 125,000 annual ED visits across 2 locations. Children and adolescents requiring mental health services are identified based on presenting complaint or from universal suicide screen. Patients are medically screened by the ED team who then consult a team of social workers specialized in acute mental health screening (AMHS). The AMHS team evaluates and provides recommendation for disposition and assists in carrying out the plan. For patients going home, the AMHS team makes 24- and 48-hour calls to the guardians to ensure safety. We collected and analyzed the data on all eligible patients from September 2015 through June 2019 for 1) demographic information, 2) trends in number of consults to AMHS, 3) disposition plans and trends by year, and 4) frequency of follow up phone calls.

Results: A total of 5,950 patient visits were reviewed, including 4,454 distinct patients. Most patients were 12-17 years of age, female, and white, with Medicaid as the predominant insurance. The most common chief complaint was suicidal ideation/plan/attempt. Majority of assessments were self-referrals and 59% (2,628/4,454) of patients were already receiving mental health services. The median response time for AMHS team was 20.7 minutes (range 5-30 minutes). There was an upward trend in AMHS consults during the study period. Psychiatric hospitalization was the most common disposition; over 95% of the other visits received timely follow up phone calls. Our data collection system changed in July 2019, and we are gathering the updated data.

Conclusions: Despite an increasing number of patients presenting to the ED with mental health crisis, safe and efficient management is possible with ED staff-social worker partnership. This approach can ensure that eligible patients receive consistent and evidence-based evaluations and allows ED clinicians to respond to medical emergencies that require their attention.

Additional Files

Impact of a Mental Health Screening Process in a Pediatric ED.pdf (236 kB)
Abstract

Table.jpg (50 kB)
Table

VisitsChart.jpg (348 kB)
Visits Chart

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May 2nd, 11:30 AM May 2nd, 1:30 PM

Impact of a Mental Health Screening Process in a Pediatric ED

Background: Up to 20% of children in the United States experience a mental health disorder and suicide is the second leading cause of death among adolescents. Children presenting with mental health concerns to the Emergency Department (ED) can be challenging due to lack of access to trained professionals and long lengths of stay. Specialized teams have shown to be beneficial, but little is known about their impact in the ED.

Objectives/Goal: This study explored the impact of specialized social workers partnering with emergency medicine providers to provide care during an acute mental health crisis.

Methods/Design: We performed this work at a quaternary children’s hospital ED with 125,000 annual ED visits across 2 locations. Children and adolescents requiring mental health services are identified based on presenting complaint or from universal suicide screen. Patients are medically screened by the ED team who then consult a team of social workers specialized in acute mental health screening (AMHS). The AMHS team evaluates and provides recommendation for disposition and assists in carrying out the plan. For patients going home, the AMHS team makes 24- and 48-hour calls to the guardians to ensure safety. We collected and analyzed the data on all eligible patients from September 2015 through June 2019 for 1) demographic information, 2) trends in number of consults to AMHS, 3) disposition plans and trends by year, and 4) frequency of follow up phone calls.

Results: A total of 5,950 patient visits were reviewed, including 4,454 distinct patients. Most patients were 12-17 years of age, female, and white, with Medicaid as the predominant insurance. The most common chief complaint was suicidal ideation/plan/attempt. Majority of assessments were self-referrals and 59% (2,628/4,454) of patients were already receiving mental health services. The median response time for AMHS team was 20.7 minutes (range 5-30 minutes). There was an upward trend in AMHS consults during the study period. Psychiatric hospitalization was the most common disposition; over 95% of the other visits received timely follow up phone calls. Our data collection system changed in July 2019, and we are gathering the updated data.

Conclusions: Despite an increasing number of patients presenting to the ED with mental health crisis, safe and efficient management is possible with ED staff-social worker partnership. This approach can ensure that eligible patients receive consistent and evidence-based evaluations and allows ED clinicians to respond to medical emergencies that require their attention.

 

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