Characteristics of Mental Health Patients Boarding for Longer than 24 Hours In a Pediatric Emergency Department

1. Pediatric patients at a tertiary care pediatric emergency department (ED) were generally boarded for more than two days, with only half receiving formal psychiatric evaluations and treatment recommendations.

2. A majority of these pediatric patients had psychiatric histories and were at risk for suicidal thoughts and behaviors, suggesting a serious need for specialized services outside of EDs.

Evidence Rating Level: 2 (Good)

The boarding of psychiatric patients in emergency departments (EDs) is a growing concern due to significant reductions in community health resources, resulting in extensive ED stays for patients whose presenting complaints extend beyond the scope of the setting. This retrospective cohort study at one urban tertiary care pediatric ED sought to evaluate the demographics and interventions used to manage patients awaiting specialized care. A total of 573 pediatric psychiatric patients were found to have been boarded for ≥24 hours between September 2015 and August 2018 (M [SD] age = 14.0 [2.9] years). Approximately 60.9% of patients were African American, 53.4% were female, and 56.2% resided within city limits. Age groups were 5-9 years (10.1%), 10-14 years (41.5%), and 15-18 years (48.3%). The most common presenting complaints were suicide ideation or suicide attempt. Depressive disorder (48.3%), anxiety disorders (33.7%), and Attention-Deficit/Hyperactivity Disorder (45.3%) were the most common psychiatric histories. Patients completed the Ask Suicide-Screening Questions and 66.0% of responses were positive; approximately half (51.5%) of patients received a formal psychiatric evaluation with treatment recommendations. Aggressive behavior was relatively limited, with 27.2% of patients requiring additional medications for sedation and 7.9% requiring physical restraints. Overall, this study highlights important gaps in psychiatric treatment that are creating undue issues in EDs and among patients in need of care. Patients generally spent more than two days in the ED but only half received formal psychiatric evaluations. This patient population included those with psychiatric histories and risk of suicidal thoughts and behaviors, yet access to necessary specialized care was unmanageable. Should this tertiary pediatric ED be representative of others across the country, improving access to psychiatric resources is essential to patient well-being.

Click to read the study in JAMA Pediatrics

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