Adolescents’ Experiences During “Boarding” Hospitalization While Awaiting Inpatient Psychiatric Treatment Following Suicidal Ideation or Suicide Attempt

Abstract

BACKGROUND: Two million adolescents experience suicidal ideation (SI) or suicide attempt (SA) annually, and they frequently present to emergency departments. Delays in transfer to inpatient psychiatric units increasingly lead to "boarding" in emergency departments and inpatient medical units. We sought to understand adolescents' perspectives during boarding hospitalizations to gain insight into helpful practices and targets for improvement. METHODS: Using convenience sampling, we conducted semistructured interviews with 27 adolescents hospitalized for SI or SA while they were awaiting transfer to an inpatient psychiatric facility. Interviews were recorded and transcribed, and the thematic analysis was organized using NVivo 11. RESULTS: Eight themes emerged: (1) supportive clinical interactions, (2) information needs, (3) repetitive inquiries, (4) safety, (5) previous hospital experiences, (6) activities and boredom, (7) physical comfort, and (8) emotions. Adolescents expressed appreciation for compassionate clinicians and for receiving information about what to expect, experienced the hospital as a safe environment, emphasized the value of staying occupied and of physical comfort, and were relieved to be receiving help to reduce their suicidal thoughts or behaviors. Reports of embarrassment and discomfort about repeated inquiries from the clinical team, comparisons with previous hospital experiences, and unanswered questions about what would occur during the planned inpatient psychiatric hospitalization were common. CONCLUSIONS: The perspectives of adolescents seeking care for SI or SA are an important source of information for health care systems seeking to improve hospital care. Clinicians can relieve distress of adolescents awaiting psychiatric hospitalization by focusing on compassionate connection, minimizing repeated inquiries, and providing complete and concrete information about treatment plans.

Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality

“…It has been discussed, that the admission to emergency care due to suicidal behavior can be a stressful situation for those seeking acute care (21), especially if specialized services for youth are lacking (22). Youth stressed the importance of information and compassionate clinicians in this situation, and stated that repeated questioning from different clinicians was perceived as negative (23). Due to the retrospective nature of our analysis, we were not able to provide information about patients´experiences with emergency psychiatric care, although this would clearly help to inform future optimization of assessment and treatment in these situations from a customer´s viepoint.…”

Pediatric Mental Health Boarding

“…In 5 of the remaining 7 studies, the authors defined boarding on the basis of transfer to an inpatient pediatric medical unit after medical clearance while awaiting an inpatient psychiatric bed. 23,25,27,29,32 Lastly, Campbell and Pierce 22 and Conrad et al 24 evaluated boarding in the ED only, defining boarding as the time from disposition decision or medical clearance in the ED until admission or transfer.…”

“…26,27 Wharff et al 31 reported that patients presenting overnight had 6.2 times the odds of boarding as those presenting from 8:00 AM to 12:00 PM, whereas significant time-of-day effects were not found in the analysis by Hoffmann et al 26 In 4 studies, authors reported processes or outcomes associated with pediatric mental health boarding beyond boarding duration and frequency. [23][24][25]32 finding that 33% of youth had improvements in their functioning during the boarding period. 25 Beyond these clinical process and outcome measures, Claudius et al 23 examined inpatient hospital costs associated with boarding, estimating an average inpatient hospital cost of $4269 per boarded patient.…”

‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study

“…The adolescents in this study confirmed this by sharing experiences of being motivated by trust and freedom as they were able to adjust BA according to their own terms. The relief from typical uncertainties of psychiatric hospitalization, including not knowing what to expect and facing repeated questioning [ 35 ], provided predictability. This is recognized from research on BA for adults, who described access to BA as a relief from fear of rejection or of being questioned [ 18 , 36 ].…”