Time study of psychiatric emergency service evaluations

The study of consultation time at the Psychiatric Emergency Service (PES) can be a valuable guide to allocation of resources in a time of scarcity. Most reports have dealth with the duration of evaluations in the medical emergncy room, but more comprehensive PES services use separate space, staff, and ‘holding units’ to allow proper handling of the psychiatric emergency. The purpose of this study was to determine what factors influence the time course of PES consultations. Consecutive evaluations done at the PES during the first quarter of 1995 ( N = 895) were reviewed. Analysis of variance with multiple comparisons and multiple linear regression techniques were used to select out significant variables and quantify their contribution to time of evaluation. Waiting times to receive psychiatric services were longer on day and evening shifts, compared with the night shift. Substance abuse diagnosis, police/mobile team referral, and the need for emergency medication also lengthened waiting times. Contact time to deliver psychiatric services was longer during the busy evening shift. It was longer if emergency medication had to be administered, if hospitalization had to be provided, or if the patient had past hospitalization history. The duration of psychiatric evaluations was greatly affected by the high acuity patient who may require management of disturbed behavior. This is different from the situation in medical ERs when the low acuity patient has the longest delays. The medical literature describes sources of delay in terms of waiting for lab tests, consults, and computed tomography results, whereas in the PES behavior management fills this role.