7. MEDICAL EMERGENCIES IN INPATIENT PSYCHIATRY: PREVALENCE OF MEDICAL TRANSFERS FROM INPATIENT PSYCHIATRIC UNITS AT AN ACADEMIC MEDICAL CENTER

Introduction

Patients with severe mental illnesses have high health utilization rates yet also have poor medical outcomes. There is some evidence to suggest that medical emergencies occur while a patient is admitted to an inpatient psychiatric unit, in the context of already poor baseline health status. As we care for older patients with medical comorbidities, there is potential that medical complexity may limit admissions to inpatient psychiatric units, posing concerns of ageism. Here, we examine the number of cases requiring transfer to inpatient medical units and the characteristics of those patients.

Methods

This was a retrospective chart review of the medical record at Strong Memorial Hospital. We reviewed the psychiatric admissions that took place from 2015-2023 and found patients that were discharged to a medical unit. We found the number of psychiatric admissions over the 8-year period and calculated the rate of transfers to inpatient medical units. We calculated the odds ratio of medical transfers based on patient characteristics, including admission to a geriatric unit, gender, length of stay, smoking status, race, and whether they required the use of restraints.

Results

From 2015-2023, there were a total of 12,496 inpatient psychiatric admissions at our hospital. Out of these admissions, a total of 307 patients required a transfer to an inpatient medicine unit. There was a noticeable shift in medical transfers that occurred during COVID, as around 8% of all patients admitted to the geriatric psychiatry unit from 2020 to 2022 required a transfer to the medical unit. Age over 65 had an OR of requiring a medical transfer of 4.79 [95%CI 3.73 6.15], admission to the geriatric unit had an OR of 2.58 [95%CI 2.03 3.30]. Black patients less likely to require a medical transfer with an OR of 0.51 [95%CI 0.38 0.70]. There were no statistically significant differences in the ORs for gender, length of stay, whether the patient required restraints.

Conclusions

It is not surprising that the rate of medical transfers is higher from the geriatric psychiatric unit, given the increasing medical complexity with age. What is surprising is that black patients were half as likely to experience a medical transfer, though possible that there are confounders that we have not yet adjusted for, which is a limitation for this study at this phase and is the next area of work. The likelihood of medical transfers based on other characteristics, including lab results of psychiatrically admitted patients remains a work in progress. This work demonstrates that there are significant numbers of patients who are admitted psychiatrically who develop medical complications serious enough to warrant transfer to a medical unit. With a better characterization of these cases, these predictors could be utilized in triage when patients first present to the hospital to determine which patients may require closer collaboration with the medicine service.