Using emergency department data to define a ‘mental health presentation’ – implications of different definitions on estimates of emergency department mental health workload

Nikita Goyal; Edmund Proper; Phyllis Lin; Usman Ahmad; Marietta John-White; Gerard M. O’Reilly; Simon S. Craig

doi:10.1071/AH24067

RESEARCH ARTICLE (Open Access)

Using emergency department data to define a ‘mental health presentation’ – implications of different definitions on estimates of emergency department mental health workload

Nikita Goyal ^A , Edmund Proper ^A , Phyllis Lin ^A , Usman Ahmad ^A , Marietta John-White ^A , Gerard M. O’Reilly ^B ^C ^D and Simon S. Craig ^A ^E ^F ^*

+ Author Affiliations

- Author Affiliations

^A Department of Paediatrics, School of Clinical Sciences at Monash Health, Sub-Faculty of Clinical and Molecular Medicine, Monash University, Clayton, Vic, Australia.

^B School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.

^C Emergency and Trauma Centre, Alfred Health, Melbourne, Vic, Australia.

^D National Trauma Research Institute, Alfred Health, Melbourne, Vic, Australia.

^E Paediatric Emergency Department, Monash Medical Centre, Clayton, Vic, Australia.

^F Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Vic, Australia.

^* Correspondence to: simon.craig@monash.edu

Australian Health Review 48(4) 342-350 https://doi.org/10.1071/AH24067

Submitted: 4 March 2024 Accepted: 22 May 2024 Published: 13 June 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objective

This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition.

Methods

This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa’s coefficient.

Results

There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58).

Conclusions

The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs.

Keywords: definition, emergency department, emergency psychiatry, hospital services, mental health presentation, psychiatric triage, self-harm, triage.

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