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Title: Barriers to providing optimal management of psychiatric patients in the emergency department (psychiatric patient management).
Austin Authors: Dombagolla, Mahesha H K;Kant, Joyce A;Lai, Fiona W Y;Hendarto, Andreas;Taylor, David McD 
Affiliation: Department of Medicine, University of Melbourne, Parkville, Vic 3052, Australia
Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Mar-2019 2019-01-29
Publication information: Australasian emergency care 2019; 22(1): 8-12
Abstract: We aimed to determine the barriers to optimal management of psychiatric patients in the emergency department (ED). We undertook an observational study in a tertiary referral ED with a 24h acute psychiatric nursing service (February to April, 2017). Following patient discharge, the attending psychiatric nurse completed a validated questionnaire to determine the barriers they encountered with their patient. Data were collected on 104 patient encounters. The environmental/resource barriers included limited space (30.8% of cases), limited time (25.0%) and ED overcrowding (22.1%). The ED staff barriers included insufficient knowledge and education regarding psychiatric illness (25.0%), negative attitudes (17.3%) and avoidance of psychiatric patients (16.3%). The patient barriers included dual diagnoses (26.0%), difficulty differentiating between psychiatric illness and social disorganisation (25.0%), and presentation issues complicating management (22.1%). The day of presentation, patient diagnosis and place of disposition were associated with the total number of barriers for each patient. Most barriers were reported on weekdays, for patients with substance abuse disorders or psychosis and for those discharged to home or an inpatient psychiatric ward. Barriers to optimal psychiatric management are common and vary considerably. These findings will inform workplace reform and education strategies aimed at mitigating the observed barriers.
DOI: 10.1016/j.auec.2019.01.001
ORCID: 0000-0002-8986-9997
PubMed URL: 30998873
Type: Journal Article
Subjects: Case management
Emergency department
Appears in Collections:Journal articles

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