Individual, social and contextual factors associated with psychiatric care outcomes among patients with intellectual disabilities in the emergency department.
Moderate or severe ID is the clearest signal that an ER crisis will lead to psychiatric consult and admission.
01Research in Context
What this study did
The team looked at emergency-department charts for people with intellectual disability.
They wanted to know who gets a psychiatric consult and who ends up staying in the hospital.
Severity of ID, living situation, and other social factors were counted.
What they found
Folks with moderate or severe ID were more likely to see the psychiatrist in the ER.
The same group also had a higher chance of being admitted for inpatient care.
Individual and social context shaped how intense the response became.
How this fits with other research
Lunsky et al. (2011) showed that life events like losing a job or moving house trigger the ER trip.
Boudreau et al. (2015) pick up where that ends: once the crisis hits the door, severity decides what happens next.
Smith et al. (1997) once said mild ID plus living alone drives service use; the new view flips it, showing moderate/severe ID drives acute care instead.
Myrbakk et al. (2008) already linked severe behavior to hidden psychiatric illness; the ER data now show those same people are the ones getting admitted.
Why it matters
When you support someone with moderate or severe ID, treat any crisis as a possible psychiatric emergency.
Flag the chart early, brief the ER team, and line up inpatient options so the person is not stuck waiting in the hallway.
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02At a glance
03Original abstract
BACKGROUND: Individuals with intellectual disabilities (ID) are disproportionately high users of psychiatric emergency services. Despite the demand for psychiatric assessments in the emergency department (ED), no clear guidelines have been established as to what factors should guide clinical decision-making processes. The current study aimed to explore individual, social and contextual factors related to psychiatric care outcomes among patients with ID in the emergency department. METHOD: Emergency department charts were reviewed for 66 individuals with ID who visited the emergency department during a psychiatric crisis. RESULTS: Standardised crisis severity scores were significantly higher in patients seen by psychiatrists as compared with patients who did not receive psychiatric consultations in the emergency department. A significantly greater proportion of patients with moderate or severe levels of ID (vs. borderline/mild) received psychiatric consultations. Emergency department visits resulting in inpatient hospital admission did not differ from those that did not, with the exception of the level of ID: patients admitted to psychiatric inpatient care were more likely to have moderate or severe levels of ID. CONCLUSIONS: The psychiatric care experiences of patients with ID in the emergency department appear highly variable. Further research focused on emergency department clinical decision-making practices concerning this population is warranted.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12201