A study of the effectiveness of psychiatric clinical liaison nurses and determinants of psychiatric admission in an accident and emergency department of Hong Kong

Abstract

Background: This study examines how psychiatric clinical liaison nurses (CLN) services in the accident and emergency department (ED) meet the demand for those people with mental health problems. In addition, we aim to identify determinants for psychiatric admission. Methods: All psychiatric patients attended the ED within the periods of May to July of 2007, May to July of 2008 and January to March 2012 were recruited. Data was recorded on patients' demographics, past mental history, time of arrival to the ED, time of discharge from the ED, length of stay in the ED, time to urgent psychiatric services (CLN services in 2008 and 2012, and urgent psychiatrist consultation in 2007), and on clinical symptoms and outcome. Results: Totally 484, 519 and 587 attendances were analysed in 2007, 2008 and 2012 respectively. Results showed that the introduction of CLN to the ED significantly shortens the waiting time for patients from registration in the ED to urgent psychiatric services, from 33.5 hours to 21.4 hours then to nine hours. However, the mean length of stay in the ED was prolonged from three hours to five hours. Overall admission rate was similar. Re-attendance rate was decreased. Five significant determinants of psychiatric admission in an attendance to the ED were identified: patients presented with psychotic symptoms, violent behavior, suicidality, known to mental health services and depressive symptoms. Conclusions: The CLN service as described in this study appears to be a useful resource in the ED for patients with mental health problems. Five determinants of psychiatric admission are identified.