Audit of the psychiatric extended care model’s impact on emergency department length of stay

Abstract

Objective Prolonged Emergency Department (ED) Length of Stay (LOS) for mental health patients adversely impacts bed flow. This study evaluated the Psychiatric Extended Care (PEC) model’s PEC-C pathway, implemented at Lyell McEwin Hospital in June 2022, which transfers select patients to the Mental Health Short Stay Unit (MHSSU) before psychiatric review. Methods This retrospective audit compared ED LOS and Total LOS between “pre-PEC” (January–April 2022) and “post-PEC” (January–April 2024) cohorts meeting PEC-C criteria (voluntary patients meeting predefined safety and medical screening criteria presenting for mental health reasons). Primary outcomes were ED LOS and Total LOS (combined ED plus MHSSU LOS). Results In 2022, 28/686 (4.1%) ED psychiatric referrals met PEC-C criteria; in 2024, 29/679 (4.3%) met criteria. For patients meeting PEC-C criteria, ED LOS decreased from 18.2 hours (IQR: 13.4–22.9) pre-PEC to 9.4 hours (IQR: 6.3–12.5) post-PEC (U = 102.5, p < .001). Total LOS showed no significant difference (69.4 hours [IQR: 7.3–131.5] vs 64.9 hours [IQR: 38.6–91.2], U = 406, p = 1.00). No adverse safety events occurred for patients meeting PEC-C criteria. Conclusion A significant reduction in ED LOS was observed following PEC implementation; Total LOS was unchanged. The quasi-experimental design limits causal inference, warranting prospective evaluation.