RESUMO
OBJECTIVE: To describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow. METHODS: A longitudinal design was used to assess number of MH presentations and LOS during a 3-year period (2014-2016). In 2017, we introduced a PIT during ED peak hours, to reduce LOS for patients with MH problems. We evaluate the effects of the PIT on patients' LOS with an 18-month before and after intervention study (2017-2018). RESULTS: Total number of ED presentations increased with 4%. Total number of MH presentations increased with 23% from 2014 to 2016. LOS increased by 28â¯min (95â¯min vs. 123â¯min) for all presentations, while not changing for MH presentations (2014: 195â¯min, interquartile range (IQR) 120-293 and 2016: 190â¯min, IQR 116-296). In the before and after intervention study, number of MH presentations increased with 36% while LOS decreased with 46â¯min (pâ¯<â¯0.001). CONCLUSIONS: The number of MH presentations increased over the three years while LOS remained similar. In the before and after intervention study, number of presentations increased even more while LOS decreased significantly. Specialist psychiatric input reduces ED LOS.
Assuntos
Transtornos Mentais/enfermagem , Adulto , Idoso , Distribuição de Qui-Quadrado , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/enfermagem , Comportamento Autodestrutivo/psicologia , Estatísticas não ParamétricasRESUMO
A 13-year-old female is described with presumed viral encephalitis, who developed progressive catatonia, agitation, and autonomic dysfunction. The diagnosis of malignant catatonia was made, and the patient improved with electroconvulsive treatment. This article discusses features, causes, differential diagnosis, and treatment of malignant catatonia. In children with this syndrome, electroconvulsive treatment should be considered.