FACTORS INFLUENCING DISPOSITION DECISIONS FOR PATIENTS SEEN IN A PSYCHIATRIC EMERGENCY SERVICE

Objective: The study examined factors influencing clinicians' decision s about disposition of patients seen in a psychiatric emergency servic e. Methods: A stratified random unduplicated retrospective sample of 3 78 patient records was drawn from the records of 1,823 patients who vi sited the emergency service of an acute care psychiatric hospital in I srael during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N=96), discharged after bri ef observation in the emergency service (N=90), admitted to a open uni t (N=104), and admitted to a locked unit (N=88). Data on demographic a nd clinical characteristics of patients and on some clinician and syst em variables were analyzed using univariate statistical techniques and stepwise logistic regression. Results: Patients were more likely to b e admitted if they were judged by clinicians to be suicidal, had more than three previous hospitalizations, were psychotic, had suicidal beh avior as the presenting complaint, and were brought to the hospital in voluntarily. Variables favoring assignment to a locked unit were age b etween 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. Conclusions: Patients' lev el of psychopathology and dangerousness were the primary factors influ encing clinicians' decisions about disposition of patients from the em ergency service.