One in 10 EMS Encounters for Involuntary Psychiatric Holds

Alameda County study shows 41 percent directly transported to standalone psych emergency services

WEDNESDAY, Jan. 2, 2019 (HealthDay News) — Ten percent of total emergency medical services (EMS) encounters in Alameda County, California, are involuntary hold encounters, according to a study published in the January issue of the Annals of Emergency Medicine.

Tarak K. Trivedi, M.D., from the University of California-Los Angeles, and colleagues used Alameda County’s standardized data set to obtain data for all EMS encounters between Nov. 1, 2011, and Nov. 1, 2016. The data were described at the patient level and encounter level after unique patient identification. The authors compared involuntary hold patients to those who were never held at the patient level and assessed the safety of out-of-hospital medical clearance by calculating the rate of failed diversion.

The researchers found that 10 percent of the 541,731 total EMS encounters were identified as involuntary hold encounters. Overall, 41 percent of these encounters resulted in direct transport of the patient to the standalone psychiatric emergency service for evaluation; 0.3 percent failed diversion and needed retransport within 12 hours. During the study period, 10 percent of the 257,625 unique patients had at least one encounter for an involuntary hold. They also had higher overall EMS use, accounting for 24 percent of all encounters. Four percent of involuntary hold patients had 20 or more encounters compared with only 0.4 percent of never-held patients.

“Further research is needed to better understand the optimal strategy for the out-of-hospital management of psychiatric emergencies,” the authors write.

Abstract/Full Text

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