Factors influencing disposition decisions for patients seen in a psychiatric emergency service

Objective: The study examined factors influencing clinicians' decisions about disposition of patients seen in a psychiatric emergency service. Methods: A stratified random unduplicated retrospective sample of 378 patient records was drawn from the records of 1,823 patients who visited the emergency service of an acute care psychiatric hospital in Israel during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N=96), discharged after brief observation in the emergency service (N=90), admitted to a open unit (N=104), and admitted to a locked unit (N=88). Data on demographic and clinical characteristics of patients and on some clinician and system variables were analyzed using univariate statistical techniques and stepwise logistic regression. Results: Patients were more likely to be admitted if they were judged by clinicians to be suicidal had more than three previous hospitalizations, were psychotic, had suicidal behavior as the presenting complaint, and were brought to the hospital involuntarily. Variables favoring assignment to a locked unit were age between 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. Conclusions: Patients' level of psychopathology and dangerousness were the primary factors influencing clinicians' decisions about disposition of patients from the emergency service.