California Children Presenting to an Emergency Department for Mental Health Emergencies

Abstract

ObjectivesPediatric emergency department (ED) mental health visits are increasing in the United States. At the same time, child/adolescent psychiatric services are limited. This study examines the trajectory of pediatric patients presenting with mental health emergencies to better understand availability of specialty care resources in regional networks.MethodsThis retrospective cohort study used a California Office of Statewide Health Planning and Development linked ED and Inpatient Discharge Dataset (2005–2015) to study pediatric patients (5–17 years) who presented to an ED with a primary mental health diagnosis. Outcomes were disposition: discharge, admission, or transfer.Patients transferred were further analyzed for disposition. Regression models to identify characteristics associated with disposition were created.ResultsThere were 384,339 pediatric patients presented for a primary mental health emergency from 2005 to 2015; 287,997 were discharged, 17,564 were admitted, and 78,725 were transferred. Among those not discharged, patients with public (odds ratio [OR], 1.28; P < 0.01) or self-pay insurance (OR, 5.64; P < 0.01), Black (OR, 2.15; P < 0.01), or Native American race (OR, 2.32; P < 0.01), and who presented to rural EDs (OR, 3.10; P < 0.01), nonteaching hospitals (OR, 3.06; P < 0.01), or hospitals in counties without dedicated child/adolescent psychiatric beds (OR, 5.59; P < 0.01) had higher odds of transfer.Among those not discharged from the second hospital, Black patients (OR, 2.47; P < 0.03) and those who were transferred to a teaching hospital (OR, 1.9; P < 0.01) had higher odds of second transfer.ConclusionsPediatric patients with mental health emergencies experience different trajectories of care. Transfer protocols and regionalized networks may help streamline services and decrease inefficiencies in care.

Child-adolescent emergency psychiatry: addressing false positive admissions

“…Among the 384,339 admissions reported by Shearer & Wang, “287,997 were discharged, 17,564 were admitted, and 78,725 were transferred.” These findings support the conclusion that emergency departments are increasingly serving as centers for urgent psychiatric stabilization. Consistent with our reporting, Shearer and Wang ( 13 ) conclude there is an insufficiency in the current system of care for managing pediatric patients who present with acute psychiatric symptoms.…”

“…Thus, the crucial role for a CRT clinician is to triage patients effectively and efficiently – a skill that is essential to reducing unwarranted emergency department admissions, helping to mitigate the excessive burden on medical staff that was most pronounced during Covid-19 (see 10 – 12 ) and continues to serve as a default department for psychiatric emergencies. In a retrospective study by Shearer and Wang ( 13 ), the authors extracted pediatric emergency mental health admissions from the California Office of Statewide Health Planning and Development Dataset (2005-2015) and restricted the age range to patients between 5-17 years old. Among the 384,339 admissions reported by Shearer & Wang, “287,997 were discharged, 17,564 were admitted, and 78,725 were transferred.” These findings support the conclusion that emergency departments are increasingly serving as centers for urgent psychiatric stabilization.…”