ABSTRACT
BACKGROUND: Pediatric emergency department (PED) visits among children and adolescents with acute mental health needs have increased over the past decade with long wait times in the PED awaiting disposition. OBJECTIVE: The objective of this study was to evaluate the effect of a new pediatric mental health liaison program with the hypothesis that this model reduces length of stay (LOS) and hospitalization rates among pediatric mental health patients. METHODS: This was a pre- and postintervention retrospective study of the year prior to (June 2012-June 2013) and the year after (October 2013-October 2014) implementation of a new PED psychiatric team. All patients aged 1-18 years with a mental health International Classification of Diseases-9(th) Revision code were included. Patients who did not receive a Psychiatry consult in the PED were excluded. RESULTS: There were 83 encounters in the year prior to and 129 encounters in the year after the implementation of the liaison program. There was an increase in the suicidality of mental health patients during this time. There was a significant decrease in mean PED LOS of 27% (95% confidence interval [CI] 0-46%; p = 0.05) from pre- to postintervention period. The decrease in the proportion of patients admitted/transferred to an inpatient psychiatric facility in the postintervention year was statistically significant (odds ratio 0.35; 95% CI 0.17-0.71; p < 0.01). CONCLUSIONS: The use of a dedicated child psychiatrist and mental health social worker to the PED results in significantly decreased LOS and need for admission without any change in return visit rate. Larger, multicenter studies are needed to confirm these findings.
Subject(s)
Emergency Service, Hospital/organization & administration , Mental Health Services/organization & administration , Pediatrics/organization & administration , Adolescent , Child , Child, Preschool , Female , Hospitalization/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Odds Ratio , Restraint, Physical/statistics & numerical data , Retrospective Studies , Suicide/statistics & numerical data , United StatesABSTRACT
BACKGROUND AND OBJECTIVES: Increasing and improving training about health literacy for US health professionals has been repeatedly called for at the national level. However, little is known about the current state of health literacy teaching in US health professions schools, including medical schools. This study aimed to provide a baseline snapshot of the quantity and characteristics of health literacy teaching in US medical schools. METHODS: We conducted a self-administered web-based survey of the deans responsible for medical education at 133 US schools of allopathic medicine. RESULTS: Data were received from 61 institutions; 72.1% of respondents reported teaching about health literacy in their required curriculum. Among schools with a required health literacy curriculum, the median time spent teaching about health literacy was 3 hours. The majority of health literacy teaching occurred in the first 2 years of the curriculum. The most commonly reported techniques for teaching about health literacy included didactics, simulated patient encounters, and workshops. Evaluation of learners was most commonly achieved using standardized patients, clinical observation, and written examinations. CONCLUSIONS: Many US allopathic schools of medicine report teaching about health literacy in their required curricula. There is considerable variability in the number of hours devoted to such instruction and in the content and teaching and evaluative techniques used in these health literacy curricula.