OBJECTIVE: The study examined factors influencing clinicians' decisions
about disposition of patients seen in a psychiatric emergency service.
METHODS: A stratified random unduplicated retrospective sample of 378
patient records was drawn from the records of 1,823 patients who visited
the emergency service of an acute care psychiatric hospital in Israel
during a seven-month period. Patients were selected from each of the
following dispositions: not admitted (N = 96), discharged after brief
observation in the emergency service (N = 90), admitted to a open unit (N =
104), and admitted to a locked unit (N = 88). Data on demographic and
clinical characteristics of patients and on some clinician and system
variables were analyzed using univariate statistical techniques and
stepwise logistic regression. RESULTS: Patients were more likely to be
admitted if they were judged by clinicians to be suicidal, had more than
three previous hospitalizations, were psychotic, had suicidal behavior as
the presenting complaint, and were brought to the hospital involuntarily.
Variables favoring assignment to a locked unit were age between 20 and 30,
dangerousness to self or others, male gender, and a low Global Assessment
of Functioning score. CONCLUSIONS: Patients' level of psychopathology and
dangerousness were the primary factors influencing clinicians' decisions
about disposition of patients from the emergency service.