For the study, researchers examined data on 871 patients who received an ED mental health evaluation at one of 10 unaffiliated Massachusetts hospitals. Researchers assessed data for demographics, insurance coverage, length of stay as well as medical, psychiatric, and social history.
According to the study, ED median length of stay changed with circumstances, driven primarily by ED boarding time. For instance, researchers said, admitted and transferred patients experienced longer delays than discharged patients (5.63, 9.32, and 1.23 hours, respectively).
Additionally, the study found that medical clearance time (1.4 hours) made up only 10.5 percent of total ED length of stay and varied little by insurance. Researchers said multivariate analyses, Medicaid patients and the uninsured had significantly longer total lengths of stay and were more than twice as likely to remain in the ED for 24 hours or greater compared with privately insured patients.
“Mental health patients in Massachusetts have lengthy ED visits, particularly those requiring inpatient admission. Boarding time accounts for the majority of total ED length of stay and varies by insurance, even when other factors known to affect ED length of stay are controlled,” the researchers concluded. “Efforts to improve timeliness of care for mental health emergencies should focus on reducing ED boarding and eliminating disparities in care by insurance status.”
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