[Measuring the emergency psychiatric units activity: An experimental application of the Delphi Method]

Abstract

Psychiatric emergency units (UUP) are nowadays important gateways to healthcare. Whether integrated into general emergency departments or not, these units have very heterogeneous resources and organisations which are not always in line with a populations' needs. The increasing activity of emergency departments in recent years and the recurrent psychiatric bed shortages have shed light upon the weaknesses of this key link in the mental healthcare process. The Seine-Saint-Denis is a department of France located in the Grand Paris metropolis in the Île-de-France region. Ranked third in terms of population size in France, it is marked by social precariousness. With regard to mental health, it has one of the lowest rates of psychiatric beds per capita in France. A great deal of thought has been ongoing for five years on how best to upgrade the offer of unscheduled psychiatric care, particularly the management of emergencies. The growing imbalance between demand and supply depending on living areas urges a rapid equalization of resources. This operation requires an accurate activity characterization, allowing more effective organizations and adequate resource allocation. We sought to characterize the activity of psychiatric emergencies by selecting quantitative and qualitative indicators by means of a consensus method, the Delphi Method, which consists of iterative questioning of an expert group. We first submitted 36 potential criteria to twenty-five experts. Twenty obtained a weak to a strong consensus. Seventeen were then selected as potentially useful for activity characterization. In a second time, we tested the consensus on selected indicators by interviewing a panel of 19 experts. A strong consensus was found on four criteria: "Number of visits for psychiatric advice>2000/year", "Number of emergency room visits>40,000/year", "Density of adult hospital beds<150 per 100,000 inhabitants", "Passage rate for homeless patients and/or outside the sector>10%". Using these criteria in the classification of UUPs would test their validity and provide a potentially helpful tool for improving organizations and resource allocation.

Keywords: Activity; Activité; Emergency department; Measurement; Mesure; Psychiatrie; Psychiatry; Service d’urgence.