Psychological distress in medical patients 30 days following an emergency department admission: results from a prospective, observational study

From the BMC:

Background

Psychological distress in medical patients admitted to the emergency department (ED) is not well studied. Our aim was to investigate the extent of psychological distress in a broad and unselected medical patient sample 30 days after ED admission and its association with socio-demographic and clinical variables.

Method

We used data from a prospective observational cohort study including 1575 consecutive adult medical patients presenting to the ED with acute somatic conditions. Outcome variables were patient’s psychological distress measured by the 4-item Patient Health Questionnaire (PHQ–4) and self-rated health assessed 30 days after ED admission using telephone interviews. Risk factors included socio-demographic variables (e.g. gender, marital status), clinical presentation (e.g. illness severity, main initial diagnosis) and course of illness (e.g. rehospitalisation, length of hospital stay).

Results

A total of 38 % of patients had evidence for psychological distress 30 days after ED admission. Multivariate analysis found female gender (adjusted odds ratio [aOR] 1.35, 95 % confidence interval [CI] 1.02 to 1.78), comorbid psychiatric disorder (aOR 1.63, 95 % CI 1.08 to 2.62), discharge to a post-acute care institution (aOR 1.47, 95 % CI 1.03 to 2.09), unplanned rehospitalisation (aOR 2.38, 95 % CI 1.47 to 3.86), and unplanned visit at general practitioner (aOR 4.75, 95 % CI 2.57 to 8.80) to be associated with distress at day 30 following ED admission.

Conclusions

One month after ED admission a significant number of patients still show a moderate amount of psychophysical distress. Strongest related variables were course of illness, in particular unplanned general practitioner visits. Future interventional studies should assess possibilities to reduce distress in patients at increased risk.

AAP Offers Guidance for Emergency Department Clinicians When Addressing Children’s Mental Health Conditions

From the American Academy of Pediatrics:

Two new clinical reports from the American Academy of Pediatrics (AAP) offer advice for clinicians in managing pediatric mental health emergencies. The AAP has issued previous recommendations for treating children with mental health issues, but these are the first that focus on mental health emergencies. The two clinical reports, “Evaluation and Management of Children and Adolescents with Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients with Mental Health and/or Behavioral Emergencies” and “Evaluation and Management of Children with Acute Mental Health or Behavioral Problems. PartII: Recognition of Clinically Challenging Mental Health Related Conditions Presenting with Medical or Uncertain Symptoms,” are published in the September 2016 Pediatrics and published online Aug. 22. The reports — and two accompanying executive summaries — cover a wide variety of childhood mental health disorders that may present to emergency physicians. Part one of the reports emphasizes the importance of ensuring patients are medically stable and that there is not a medical condition exacerbating a mental health condition. It also reviews when to conduct diagnostic testing, such as toxicology, pregnancy and sexually transmitted infection tests. The report offers guidance on evaluating pediatric patients for suicide risk and management of patients who have attempted suicide, including outpatient management, hospitalization and coordinating care with the medical home care. Part two discusses evaluating somatic illnesses, including communicating with the patient and family. It also addresses adverse effects from psychiatric medications as well as recommendations in managing children with special needs, including autism and developmental disorders and the unique challenges their conditions bring in crisis situations.

Seniors with More Continuity of Care Use the ER Less

Press Release:

Seniors with traditional Medicare coverage who have more continuity of care – defined as consistently seeing the same physician in an outpatient setting – have lower chances of visiting an emergency department, according to the results of a study published online earlier this month in Annals of Emergency Medicine (“Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults”).

“Higher continuity of care was associated with lower risk of having any emergency department visit,” said lead study author David Nyweide, Ph.D, of the Centers for Medicare & Medicaid Services in Baltimore, Md. “However, when one occurred, the patient was more likely to be hospitalized. One possible explanation is that when a patient with a usual care physician comes to the ER, the physician may provide clearer guidance on which situations are serious enough to warrant a hospital admission.”

Researchers studied the administrative data of more than 3 million Medicare beneficiaries between 2011 and 2013 and found that the relative risk of an emergency department visit, observation stay or admission through the emergency department decreased up to 20 percent for patients with the highest, compared with the lowest, continuity of care.

“Visits with the same physician or a small number of physicians fosters long-term relationships for Medicare patients, which is ultimately good for their health,” said Mr. Nyweide. “The critical factor seems to be consistent visits with one physician or few physicians, not lots of them. Seniors would be well-advised to maintain an ongoing relationship with the same physician for many reasons, including avoiding emergency department visits.”

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit www.acep.org.

Public Health Officials Struggle To Identify Sepsis Before It Becomes Deadly

From the Kaiser Health Network:

The federal Centers For Disease Control and Prevention Tuesday released a study about sepsis as part of an effort to draw attention to the importance of prevention and early detection of the disease.

“Early treatment is vital,” said Dr. Anthony Fiore, chief of the epidemiology research and innovations branch at the CDC’s Division of Healthcare Quality Promotion. “It’s an emergency that you need to deal with, like heart attack and stroke.”

When sepsis advances to septic shock, characterized by severely low blood pressure, each hour of delay in administering antibiotics decreases the odds of survival by an average 7.6 percent, one study found.