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Utilisation of emergency departments of behavioural disorders and supply of workforce in Nebraska
  1. Rajvi Jayant Wani1,
  2. Shinobu Watanabe-Galloway1,2,
  3. Hyo Jung Tak1,
  4. Li-Wu Chen1,
  5. Nizar Wehbi1,
  6. Fernando Wilson3
  1. 1 Department of Health Services Research, Administration and Policy, University of Medical Center, Omaha, Nebraska, USA
  2. 2 University of Utah School of Medicine, Salt Lake City, Utah, USA
  3. 3 Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, United States
  1. Correspondence to Dr Rajvi Jayant Wani, University of Nebraska Medical Center, Omaha, NE 68198, USA; wani.rajvi{at}


Background Emergency departments (EDs) have become entry points for treating behavioural health (BH) conditions, thereby rendering the evaluation of their utilisation necessary.

Objectives This study estimated behavioural-related hospital-based ED visits and outcomes of leaving against medical advice as well as the incurred charges within the primarily rural State of Nebraska. Also, the study correlated behavioural workforce distribution and location of EDs with ED utilisation.

Methods Nebraska State Emergency Department Database provided information on utilisation of services, charges, diagnoses and demographic. Health Professional Tracking Services survey provided the distribution of EDs and BH workforce by region. To examine the effect of patient characteristics on discharge against medical advice, multivariable logistic regression modelling was used.

Findings US$96.4 million were ED charges for 52 035 visits for BH disorders over 3 years. Of these, 35% and 50% were between 25 and 44-years old and privately insured, respectively. The uninsured (OR:1.53, p=0.0047) and 45–64 years old (OR:2.31, p<0.001) had higher odds of leaving against medical advice. The findings from this study identified ED outcomes among high-risk cohort.

Conclusions There were high ED rates among the limited number EDs facilities in rural Nebraska. Rural regions of Nebraska faced workforce shortages and had high numbers of ED visits at relatively few accessible EDs.

Clinical implications Customised rural-centric public health programmes, which are based in clinical settings, can encourage patients to adhere to ED-treatment. Also, increasing the availability of BH workforce (either via telehealth or part-time presence) in rural areas can alleviate the problem and reduce ED revisits.

  • emergency services
  • behavioral health conditions
  • mental health
  • substance-related disorders
  • health services
  • rural health

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  • Contributors RJW and FW conceived of the presented idea. RJW and SW-G developed the theory and performed the analyses. HJT and L-WC verified the analytical methods. NW encouraged RJW to understand policy implications and supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data was obtained from Healthcare Cost and Utilization Project which is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.