1. Emergency department pediatric psychiatric services
Measurement of variation and identification of best practice
Jennifer Field Brown, Ph.D., MSN, BSN, BA
Assistant Professor • School of Nursing • Virginia Commonwealth University • Richmond, VA, USA
Purpose
The purpose of this study is to evaluate the feasibility of a proposed data measurement and collection procedure for identifying ED pediatric psychiatric service characteristics. This pilot will examine such services across the Commonwealth of Virginia.
Discussion and conclusions
Problem
Methods
target sample=70 hospitals; 39 responses to date,
(56%) online:35, mail:4, phone:0
recruitment has been difficult, requiring multiple
follow up contacts - had to extend data collection
period
average time spent to complete online survey:24 min
most EDs offer psychiatric service but pediatric
specialists RARE
Variability in the training of psychiatric staff
Ratings of service quality middle-of-the-road
ED pediatric psychiatric visits unpredictable and
challenging to manage
Survey effective in capturing variation in ED pediatric
emergency services. The findings will guide
improvements to the research design for replication
using a national sample. Such research will inform
legislators, hospitals, and other personnel involved in
ED pediatric psychiatric service development and
evaluation.
Annual volume of pediatric psychiatric visits to hospital emergency departments (EDs) continues to increase significantly, but little is known about the mental health services that are provided to children and adolescents in this setting
Lack of information to guide “best practices” related to pediatric psychiatric emergency services
Most existing research limited to single organization or geographic location
Limited usability of secondary datasets - Research on prevalence of ED pediatric visits for psychiatric services using National Ambulatory Care Hospital Survey cannot capture organizational influences – need for additional data
Need for systematic identification and comparison of ED pediatric psychiatric services within and across regions/states
PI revised an instrument she had designed for a previous study of adult ED psychiatric services (Brown, 2005)
31-item ED Pediatric Psychiatric Services Survey used to obtain information about ED management of children who present
with a mental health problem
Identified target sample for pilot test (nonfederal acute-care facilities within the Commonwealth of Virginia) using 2006
American Hospital Association Dataset
Contacted each hospital to identify appropriate respondent (ED nurse manager/administrator)
Offered participants choice of response methods: online, paper & pencil/mail, phone interview
Administered survey over 6 month period, combined survey data with AHA data to examine association between
organizational characteristics and ED pediatric psychiatric service variation
In process of conducting descriptive and inferential analyses
Findings
Background
Recommendations/
Future Directions
Statistics support the need for pediatric psychiatric emergency services in Virginia to improve the identification and treatment of illness. The estimated number of Virginia children and adolescents between 9 and 17 years of age with a serious emotional disturbance was between 80,017 and 97,801.* Yet less than a third are receiving appropriate treatment. In 2006, 30,000 children and adolescents received mental health and substance abuse services in the community mental health system. In addition, the state psychiatric hospitals served 887 children.
Sample - Include freestanding EDs, replicate with
national/international sample
Survey - further revision??, implement strategies
for improving response rate
Data - Identify additional sources for objective
descriptive information
Further research to identify disparities in EDPES
structures and outcomes, to determine causality,
and to identify what constitutes best practice –
include analysis of the association of geographical
(rural/urban, state) and demographical (patient
race/ethnicity) characteristics
* Estimate made using an accepted methodology for estimating prevalence of serious emotional disturbance (Friedman et. al., 1998) and year 2000 census data, Data were insufficient to make prevalence estimates for children younger than nine.
This project was supported by a grant from the A.D. Williams
Foundation at Virginia Commonwealth University.
V i r g i n i a C o m m o n w e a l t h U n i v e r s i t y