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Factors associated with psychiatric admission from observation beds in the psychiatric emergency room
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DOI：10.3389/fpsyt.2026.1857966.png)
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Abstract
En 中文
BackgroundPsychiatric emergency services frequently utilize observation units to support disposition decisions when diagnostic uncertainty exists; allowing for extended psychiatric supervision to inform medical decision-making. Yet there is limited data describing predictors of inpatient admission following observation; and understanding which factors are associated with this outcome may improve clinical decision-making and resource utilization.MethodsWe conducted a retrospective chart review of adult patients placed in an observation unit within a high-volume urban psychiatric emergency service between April 1 and June 30; 2019. Demographic; psychiatric; and substance-related variables were extracted from the electronic medical record. The primary outcome was disposition to acute inpatient psychiatric admission versus no psychiatric admission. Univariate analyses were performed; followed by multivariable logistic regression to identify factors independently associated with admission.ResultsAmong 269 patients placed in observation; 81 (30.1%) were admitted to an acute inpatient psychiatric unit and 188 (69.9%) were not admitted to an acute psychiatric inpatient unit. In multivariable analysis; factors associated with increased odds of psychiatric admission included delusions (aOR 2.94; 95% CI 1.46-5.94); depression (aOR 2.27; 95% CI 1.17-4.43); involuntary commitment status at presentation by either a civilian (aOR 3.65; 95% CI 1.43-9.37) or physician/law enforcement (aOR 2.07; 95% CI 1.10-3.90); and absence of a breathalyzer test (aOR 3.58; 95% CI 1.56-8.19). A decreased likelihood of psychiatric admission was associated with patients with two or more prior observation discharges (aOR 0.26; 95% CI 0.08-0.84); and self-reported substance use within the prior 72 hours (aOR 0.46; 95% CI 0.25-0.84).ConclusionsIn this psychiatric emergency cohort; delusions; depressive symptoms; involuntary commitment status at presentation; and absence of a completed breathalyzer were associated with increased odds of acute psychiatric admission; while self-reported substance use within the prior 72 hours and two or more prior observation discharges were associated with decreased odds. These findings should be interpreted as hypothesis-generating given the observational design; limited study window; and single-site sample. Validation in larger; multi-site; multi-season cohorts is needed before these associations can inform clinical decision-making or be incorporated into disposition prediction tools.
Keywords:
psychiatric symptoms
inpatient psychiatric care
observation unit care
psychiatric admission
psychiatric emergency
psychiatric emergency care
psychiatric emergency triage
psychiatric observation unit
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