Incident reports and linked data on patients with psychomotor agitation in the emergency department

Background

Psychomotor agitation (PMA) is a high-risk condition for patients and staff safety, posing significant clinical and organisational challenges.

Methods

In the Romagna Local Health Authority, one of the largest in Italy (about 1.1 million inhabitants), 2023 and 2024 incident reports related to PMA were reviewed, informing subsequent analyses. Within the EIRENE project, approved by the Ethics Committee, a retrospective observational study across seven Emergency Departments (EDs) was carried out using data from June 2023 to May 2024. ED records were linked via a unique identifier with community mental health and addiction services, and laboratory data on urine drug screening. Patients characteristics and care pathways were analysed.

Results

Incident reports highlighted clinical complexity, patient vulnerability, and critical issues in care processes and pathway management; EDs emerged as the most affected settings. Out of 362,641 EDs visits, 6,626 were classified as potential PMA visits, corresponding to 4,829 patients; 16% had repeated visits. Most patients were aged 18–39 years. 3,158 psychiatric consultations were requested (47.7% of visits), almost a third of which in one ED. Urine drug screening was requested in 19.7% of visits, with an overall positivity rate of 64%, and a degree of variability across EDs. Ambulance was the most frequent mode of arrival (62.9%), and most visits resulted in home discharge (68.3%), while 20.2% resulted in hospitalisation. Linkage with mental health services data showed that 29.5% of patients had contact with services in the prior year, while 8.7% entered care after the ED visit.

Conclusions

Using incident reports combined with a focused analysis of multiple data sources made it possible to identify actionable vulnerabilities in the management of PMA. The findings informed targeted organisational actions developed through 2025 to improve management and continuity of care for these patients.

Key messages

• Precise characterisation of a population subgroup presenting to emergency departments enables the development of targeted strategies.

• Overcoming siloed data by using multiple sources enables a more comprehensive understanding of complex health phenomena.