‘It’s an outrage’: Psychiatric patients face long waits, stays in unprepared EDs

Patients experiencing psychiatric emergencies may wait for up to five days for a bed in an emergency department (ED), according to a survey released by the American College of Emergency Physicians (ACEP).

In a poll of more than 1,700 emergency physicians presented at ACEP’s annual meeting in Las Vegas, 75 percent said they saw at least one patient per shift who needs to be hospitalized for psychiatric treatment. Nearly half (48 percent) reported at least one patient per day had to be held in the ED waiting for a bed or transfer to another facility, with 21 percent seeing patients waiting between two and five days for a bed.

“More than half of emergency physicians say the mental health system in their communities has gotten worse in just the last year, and the consequences of that play out in our emergency departments," ACEP President Rebecca Parker, MD, said in a statement. "Psychiatric patients wait in the emergency department for hours and even days for a bed, which delays the psychiatric care they so desperately need. It also leads to delays in care and diminished resources for other emergency patients. The emergency department has become the dumping ground for these vulnerable patients who have been abandoned by every other part of the healthcare system."

The “severe shortage” of psychiatric beds in most hospitals leads to the long stays, according to Parker, who called the situation “an outrage.”

Studies accompanying the survey illustrate this problem isn’t a new one. Looking at data between 2002 and 2011, one of the studies found psychiatric patients between 2002 and 2011 were more likely to require hospitalization or transfer or be subjected to long waits in the ED than medical patients.

The odds for a prolonged stay went up when patients had bipolar disorder, psychosis, dual diagnosis, multiple psychiatric diagnoses and/or depression, according to the other accompanying study.

Mental health patients have few options besides EDs, according to Suzanne Lippert, MD, MS, of Stanford University and lead author of the two studies. The result can be delayed emergency care for all patients—and a potentially dangerous situation for other patients and workers in those departments.

"In a time of decreased psychiatric in-patient beds and variable access to outpatient psychiatric centers, we are looking at a potential crisis of unmet psychiatric need,” Lippert said. “Clinical outcomes for psychiatric patients subjected to prolonged emergency department lengths of stay must be examined alongside the impact of these stays on emergency department crowding."