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BACKGROUND: The characteristics of Emergency Department (ED) attendances due to mental or behavioural health disorders need to be described to enable appropriate development of services. We aimed to describe the epidemiology of mental health-related ED attendances within health care systems free at the point of access, including clinical reason for presentation, previous service use, and patient sociodemographic characteristics. METHOD: Systematic review and meta-analysis of observational studies describing ED attendances by patients with common mental health conditions. FINDINGS: 18 studies from seven countries met eligibility criteria. Patients attending due to mental or behavioural health disorders accounted for 4% of ED attendances; a third were due to self-harm or suicidal ideation. 58.1% of attendees had a history of psychiatric illness and up to 58% were admitted. The majority of studies were single site and of low quality so results must be interpreted cautiously. CONCLUSIONS: Prevalence studies of mental health-related ED attendances are required to enable the development of services to meet specific needs.

BACKGROUND: The impact of delayed discharge on patients, health-care staff and hospital costs has been incompletely characterized.AIM: To systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients' outcomes and costs.METHODS: Four of the main biomedical databases were searched for the period 2000-2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included.RESULTS: Thirty-seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients' mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well-being. Extra bed-days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients.CONCLUSIONS: The poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.

Tesis Univ. Granada. Departamento de Economía Aplicada, Este trabajo ha sido financiado por la Escuela Andaluza de Salud Pública (EASP), la Fundación Pública Andaluza para la Investigación Biosanitaria de Andalucía Oriental (FIBAO) y el Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP) y se ha realizado bajo la dirección de la Escuela Andaluza de Salud Pública.