Boarding of Children With Mental Health Conditions in the Emergency Department

December 18, 2019

Link to Research Article

https://www.ajemjournal.com/article/S0735-6757(18)31003-9/fulltext

Article Citation

Hoffmann JA, Stack AM, Monuteaux MC, Levin R, Lee LK. Factors associated with boarding and length of stay for pediatric mental health emergency visits. Am J Emerg Med. 2018 Dec 23. [Epub ahead of print].

First Dose

  • Pediatric mental health visits to the emergency department have been increasing over time, with some visits resulting in boarding (a length of stay over 24 hours).
  • Boarding may occur when there is no appropriate placement available for a higher level of care, such as an inpatient psychiatric hospitalization.
  • The authors found that some groups of children are disproportionately more likely to board, thereby delaying access to definitive mental health care.
  • Among other factors, boarding was associated with insurance status, co-occurring autism or developmental delay, and prior psychiatric hospitalization.

Key Points to Remember

  • The authors conducted a retrospective cross-sectional analysis of mental health visits for children 5–18 years old presenting to a tertiary pediatric emergency department in 2016.
  • Multivariate logistic regression was used to identify demographic and clinical factors associated with boarding.
  • Of 1746 mental health visits, 386 (22%) visits had a length of stay >24 hours.
  • Children were more likely to board if they had private insurance relative to public insurance, if they presented during a school month, if physical or pharmacological restraints were used, if they had autism or developmental delay, if they had a prior psychiatric hospitalization, and if they had certain reasons for presentation (including agitation, suicidal ideation, or psychosis) relative to anxiety.
  • The disparity by insurance status suggests a need to work towards achieving comprehensive mental health coverage across all insurance plans.
  • The difficulty in placing children with autism and developmental delay highlights the need for specialized facilities that have adequate expertise and resources to care for these children.
  • Overall, boarding of children in the emergency department demonstrates insufficient availability of resources in the mental health system, and these findings may inform targeted improvements for the groups of children disproportionately affected.

Summary Author

Jennifer Hoffmann, MD

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