• Grace Chang, Anthony Weiss, Joshua M Kosowsky, Endel John Orav, Jennifer A Smallwood, and Scott L Rauch.
• Department of Psychiatry, Department of Veterans Affairs Boston Health Care System, 940 Belmont St., Brockton, MA 02301, USA. grace.chang2@va.gov
• Psychiatr Serv. 2012 Mar 1;63(3):283-6.

ObjectiveThis study identified characteristics of adult psychiatric patients who remained for 24 or more hours in the emergency departments of general hospitals in Massachusetts.MethodsData were collected starting in June 2008 on a prospective cohort of 1,076 patients who presented for emergency psychiatric evaluation at one of five hospitals.ResultsA total of 90 patients (8%) stayed 24 or more hours (median=31 hours). More than 90% (N=1,018) of all patients had health insurance. Characteristics associated with extended stays included homelessness, transfer to another hospital, public insurance, and use of restraints or sitters (p<.05). The two academic medical centers had higher proportions of extended-stay patients than the three community hospitals (12% and 15% versus 1%, 7%, and 7%, respectively; p<.001).ConclusionsDespite overall high rates of health insurance coverage, publicly insured patients waited longer than those with private insurance. Future reforms of Massachusetts' mandatory health insurance program should consider treatment capacity as well.

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