Objective Psychiatric boarding occurs when patients remain in emergency departments (ED) or are admitted to inpatient medical/surgical units to await placement at psychiatric treatment programs. Boarding was already increasing in the United States (US) over the past decade, and the COVID-19 pandemic has only further profoundly affected the mental health of youth. The current study aims to describe psychiatric diagnoses and boarding among pediatric patients presenting to the hospital after the pandemic onset. Methods We performed a retrospective chart review from March 2019 to February 2021 of all youth ≤ 18 years with ED or inpatient medical/surgical admissions related to mental health complaints at a large US Northeast pediatric hospital and compared psychiatric diagnoses and boarding during the 12-months before and after the pandemic onset. Inferential statistics included chi-square and t-tests. Interrupted time series analyses evaluated trends during the study period. Results Proportion of hospital presentations of pediatric patients with suicidal ideation/suicide attempts (p<0.001), depression (p<0.001), anxiety (p=0.006), eating disorders (p<0.001), substance use disorders (p=0.006), and obsessive compulsive and related disorders (p<0.001), all increased during the first pandemic year, compared with the prior year. Average length of psychiatric boarding more than doubled [2.1 vs 4.6 days, p<0.001] and 50.4% of patients experienced extended boarding periods ≥ 2 days during the first pandemic year. Conclusions This study highlights the vulnerability of a US healthcare system that has been chronically inadequate at meeting the mental health needs of children and adolescents and raises an urgent call to reform pediatric mental health care.

Quality improvement strategies that incorporate pay-for-performance incentives can be used effectively to expand palliative care services to underserved populations.