COVID-19 pandemic and emergency department visits for psychosis: Visit volume, restraint use, medication use, psychiatric hospitalization, and length of stay

Abstract

Background: Individuals with a schizophrenia spectrum disorder were at heightened risk for interruptions in psychiatric care during the coronavirus-19 (COVID 19) pandemic. There is limited work exploring the pandemic's impact on emergency department (ED) visit volume, use of restraint and parenteral medications, inpatient psychiatric (IP) hospitalization, and ED length of stay (LOS) among this population.

Methods: We retrospectively examined 2134 ED visits with a billing code for psychosis between March 1, 2019-February 28, 2021. We used Poisson regression analysis to compare ED visit volume between the pandemic and pre-pandemic periods. Restraint use, parenteral antipsychotic or benzodiazepine use, IP hospitalization, and ED LOS were compared between the two periods using chi-square tests and independent samples t-tests.

Results: Overall volume of psychosis-related ED visits during the pandemic did not differ significantly from the prior year. Rates of restraint use (16.2 % vs 11.6 %, p < .01), parenteral antipsychotic (22.6 % vs 14.9, p < .001), and parenteral benzodiazepine (22.3 % vs 16.3 %, p < .001) use were significantly higher during the pandemic. Fewer patients had an IP hospital disposition during the pandemic than the year prior (57.8 % vs. 61.9 %, p < .05). ED LOS was longer during the pandemic compared to pre-pandemic (28.37 h vs 20.26 h, p < .001).

Conclusions: Although the volume of psychosis-related ED visits remained constant, restraint and parenteral medication use rates were significantly higher during the pandemic. ED LOS increased but fewer ED visits resulted in IP hospitalization. These findings underscore the importance of planning for increased acuity of psychosis ED presentations during public health emergencies.

Keywords: Antipsychotic; Covid-19; Emergency visit; Inpatient hospitalization; Psychosis; Restraint.