Characteristics,clinical care,and disposition barriers for mental health patients boarding in the emergency department |
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Affiliation: | 1. Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;2. Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea;3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;1. Department of Psychiatry, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States;2. Department of Emergency Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States;3. Department of Health Sciences Research, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States;4. Department of Information Technology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States;1. Department of Emergency Medicine, University of Iowa Carver College of Medicine, USA;2. University of Iowa, USA;3. University of Iowa Carver College of Medicine, USA;4. Department of Emergency Medicine and Psychiatry, University of Iowa Carver College of Medicine, USA |
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Abstract: | Background and objectivesLack of mental health resources, such as inpatient psychiatric beds, has increased frequency and duration of boarding for mental health patients presenting to U.S. emergency departments (EDs). The purpose of this study is to describe characteristics of mental health patients with an ED length of stay of one week or longer and to identify barriers to their disposition.MethodsThis study was conducted in an academic ED in which emergency psychiatric evaluations and care are provided by a Psychiatric Emergency Services (PES) team contained within the Department of Emergency Medicine. Prolonged boarding was defined as an ED length of stay of 7 days or more. Pediatric, adult, and geriatric mental health patients with prolonged ED boarding from January 1 to August 31, 2019 were included. This study includes prospective data collection of the boarding group and retrospective identification and data collection of a comparison group of non-barding patients over the same 8-month period to compare patient characteristics and outcomes for each group.ResultsBetween January 1 and August 31, 2019, the PES team completed 2,745 new assessments of mental health patients, of whom 39 met criteria for prolonged ED boarding. The following characteristics were associated with boarding: child (8%), male (64%), having Medicaid (49%) or both Medicaid and Medicare (18%), and having either a neurodevelopmental (15%) or neurocognitive disorder (15%) with a median stay of 18 days. Barriers to discharge included being declined from all state inpatient psychiatric hospitals (69%), declined from community living environments (21%), or declined from both (10%). The most common ED non-boarding patients were: Caucasian (64%), have a diagnosis of unspecified mental disorder (including suicidal ideation) or other specified mental disorder (59%) and have private insurance (42%) with a median stay of 1 day.ConclusionIn this study of mental health patients with prolonged ED stays, the primary barrier to disposition was the lack of patient acceptance to inpatient psychiatric hospitals, community settings, or other housing. Early identification of potential prolonged boarding, quality treatment and care for those patients, and effective case management, may resolve the ongoing challenges of boarding within the ED. |
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