Understanding Psychological Distress and Therapeutic Environment in the Emergency Department

Обзор

This research aims to establish the number of patients coming to Emergency Departments (EDs) with issues relating to mental health, alcohol or drugs, or in some form of psychological distress, including those for whom this was not the main reason for attending ED. We will collect anonymous information on age, gender, ethnicity, when and how they came to the ED, where and how they are cared for whilst in the ED, and what happens to them afterwards. With this information we hope to build a better picture of these patients so we can go on to design and test ways to improve their care in the future.

Подробное описание

Those presenting to the Emergency Department with mental ill health, substance misuse or in crisis have a worse patient journey than those presenting with physical issues alone. They wait twice as long to be seen1 and have poorer experiences. Recognising this, the RCEM/James Lind Alliance Priority Setting Partnership has placed mental health at the top of the Emergency Medicine research agenda. The question asked is: "How can care for mental health patients be optimised, whether presenting with either/both physical and mental health needs; including appropriate space to see patients, staff training, early recognition of symptoms, prioritisation, and patient experience?" An explicit research agenda has yet to emerge from this very broad question. At the most basic level, the patient population needs to be defined, the scale of the problem quantified, and current practice patterns and variation described in detail.

It has been estimated that the proportion of ED attendances related to "mental health disorders" is 4%. However these estimates are derived from retrospective data and are dependent on accurate diagnosis coding. There is a lack of data on dual diagnoses, which Scotland's Mental Health strategy has outlined as a key area for action, recommending opportunities to "pilot improved arrangements for dual diagnosis for people with problem substance use and mental health diagnosis". A literature review aiming to build a 'Typology' of psychiatric emergency services in the UK emphasised wide variation in provision and heterogeneity of models. No prospective study has yet quantified this variation in terms of waiting times, types of assessment offered, disposition and outcomes. The success of other large observational studies on ED presentations such as syncope, acute aortic syndromes and frailty suggests that a similar methodology could be applied to mental health and related presentations.

Вмешательства

• Поведенческое Routine Care
  This study involves no change in clinical care and no study specific interventions for participants.

Первичные конечные точки

• Proportion fo ED attendance related to issues of mental health, substance use or psychological distress [Срок оценки: 7 days]

Вторичные конечные точки (9)

• Proportion of patients physically in ED who meet inclusion criteria at any one time [Срок оценки: 7 days]
• Comparison with coding data [Срок оценки: 7 days]
• Admission rate [Срок оценки: 7 days]
• Length of stay [Срок оценки: 30 days]
• Specialist mental health or addictions input in ED [Срок оценки: 7 days]
• Specialist referrals from ED [Срок оценки: 7 days]
• 7-day and 30-day follow-up [Срок оценки: 30 days]
• Clinician Confidence Scale [Срок оценки: 7 days]
• Resource Availability Scale [Срок оценки: 7 days]

Критерии участия

Критерии включения

• Issues of mental health AND/OR
• Issues of substance use AND/OR
• Psychological distress (this refers to patients without an established mental health or substance use disorder who nonetheless present in a distressed state, where distress is not caused by a readily identifiable and treatable physical condition) AND/OR
• Where the treating ED team feel the patient would benefit from some form of mental health or addictions assessment or intervention, whether carried out by ED staff, specialist services or third sector agencies.

Критерии исключения

• Patients aged 10 and under.
• Patients with distress caused by a physical condition, relieved by appropriate treatment.
• Delirium, unless caused by a mental health- or substance-related disorder.
• Patients with alcohol intoxication alone, without other evidence of harmful use of alcohol and without evidence of psychological distress.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Когортное

Центры проведения

Великобритания · 1 центр

• Victoria Hospital — Kirkcaldy

Публикации

• European Taskforce on Geriatric Emergency Medicine (ETGEM) collaborators. Prevalence of Frailty in European Emergency Departments (FEED): an international flash mob study. Eur Geriatr Med. 2024 Apr;15(2):463-470. doi: 10.1007/s41999-023-00926-3. Epub 2024 Feb 10. PMID 38340282
• McLatchie R, Reed MJ, Freeman N, Parker RA, Wilson S, Goodacre S, Cowan A, Boyle J, Clarke B, Clarke E; DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024 Feb 20;41(3):136-144. doi: 10.1136/emermed-2023-2 PMID 37945311
• Reed MJ, Karuranga S, Kearns D, Alawiye S, Clarke B, Mockel M, Karamercan M, Janssens K, Riesgo LG, Torrecilla FM, Golea A, Fernandez Cejas JA, Lupan-Muresan EM, Zaimi E, Nuernberger A, Rennet O, Skjaerbaek C, Polyzogopoulou E, Imecz J, Groff P, Camilleri R, Cimpoesu D, Jovic M, Miro O, Anderson R, Laribi S; SEED investigators. Management of syncope in the Emergency Department: a European prospect PMID 38015745
• Odejimi O, Bagchi D, Tadros G. Typology of psychiatric emergency services in the United Kingdom: a narrative literature review. BMC Psychiatry. 2020 Dec 10;20(1):587. doi: 10.1186/s12888-020-02983-5. PMID 33302905
• Scottish Government (2017) Mental Health Strategy: 2017-2027. Crown Copyright. Available at: https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2017/03/mental-health-strategy-2017-2027/documents/00516047-pdf/00516047-pdf/govscot%3Adocument/00516047.pdf
• Barratt H, Rojas-Garcia A, Clarke K, Moore A, Whittington C, Stockton S, Thomas J, Pilling S, Raine R. Epidemiology of Mental Health Attendances at Emergency Departments: Systematic Review and Meta-Analysis. PLoS One. 2016 Apr 27;11(4):e0154449. doi: 10.1371/journal.pone.0154449. eCollection 2016. PMID 27120350
• Baracaia S, McNulty D, Baldwin S, Mytton J, Evison F, Raine R, Giacco D, Hutchings A, Barratt H. Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014. Emerg Med J. 2020 Dec;37(12):744-751. doi: 10.1136/emermed-2019-209105. Epub 2020 Nov 5. PMID 33154100
• Royal College of Emergency Medicine (2022) James Lind Alliance Emergency Medicine Priority Setting Partnership Refresh 2022. Available at: https://rcem.ac.uk/research-priorities/

Идентификаторы

NCT: NCT06655467 · 24/EM/0245

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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