Characteristics of children boarding in emergency departments for mental health conditions in a rural state

Marquis, Taylor; Callas, Peter W.; Schweitzer, Nathan; Bisanzo, Mark; McGowan, Haley; Sexton, Ryan J; Pulcini, Christian D.

doi:10.1111/acem.14509

Cited by 4 publications

(10 citation statements)

References 6 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Five EDs reported less than 1800 pediatric visits per year (average of five or fewer per day) and seven EDs reported less than 5000 pediatric visits per year (average of six to 13 per day). Previous study in these settings reported no more than one to two pediatric patients boarding for mental health conditions at any given time in any ED, with the average boarding time being 3 days for pediatric patients awaiting transfer to an inpatient psychiatric facility 5 . All respondents indicated that their staff distributed the youth activity kits and that they were either satisfied or very satisfied.…”

Section: Question/responses No Of Respondents (%)mentioning

confidence: 97%

Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns

Pulcini,

Schneider,

Wolfley

et al. 2023

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Children presenting to emergency departments (ED) for mental health concerns have increased nationally, resulting in ED boarding due to the lack of infrastructure for needed treatment. 1,2 ED boarding is defined by The Joint Commission as "the process of holding patients in a temporary location after the decision to admit or transfer has been made" and recommends a duration of less than 4 h. 3 The majority of children in the United States are evaluated and board in general EDs where there is limited pediatric or psychiatry expertise. 4,5 Despite the ongoing mental health crisis, 6 few interventions to improve the experience of boarding children and adolescents in the ED have emerged. This is especially true for general and critical access EDs who have requested more guidance on safe activities to provide pediatric patients while boarding. 7 We therefore implemented a statewide initiative in rural EDs through distribution of (1) youth activity kits and (2) a self-care activity binder designed to assist staff in caring for children boarding with primary mental health concerns. The youth activity kits contained assorted toys, games, art/sound supplies, meditation, and distraction items. The self-care activity binders included team communication enhancements, mindfulness activities, and fitness activ-How to cite this article: Pulcini CD, Schneider S, Wolfley H, Collins B, Li J. Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns.

show abstract

Section: Question/responses No Of Respondents (%)mentioning

confidence: 97%

Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns

Pulcini,

Schneider,

Wolfley

et al. 2023

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…An estimated 1 in 4 patients boarding in the ED required medication for aggressive behavior, and nearly 1 in 10 required physical restraints. 4 Behavioral response teams (BRTs) have played an invaluable role in supporting patients, families, and staff dealing with BH crises at nonpsychiatric medical centers. 7 A BRT was established at this medical center in 2009 with the hiring of 1 psychiatric RN.…”

Section: Project Purposementioning

confidence: 99%

“…3 The Joint Commission's standard regarding patient flow recommends boarding time in EDs not to exceed 4 hours in the interest of patient safety and quality of care. 4 Admitting pediatric BH patients awaiting inpatient and outpatient psychiatric placement onto medical and surgical units helps to decompress patient flow and capacity issues impacting EDs, but infrastructure challenges for providing high-quality delivery of care remain. 5 Pediatric medical and surgical units' physical environments are not designed for providing therapeutic milieu or safety for patients at risk for self-injury, aggressive, or destructive behaviors.…”

mentioning

confidence: 99%

“…In addition, the lack of funding and the shortage of community-based mental health treatment programs and inpatient psychiatric beds have added to this crisis 3 . The Joint Commission's standard regarding patient flow recommends boarding time in EDs not to exceed 4 hours in the interest of patient safety and quality of care 4 . Admitting pediatric BH patients awaiting inpatient and outpatient psychiatric placement onto medical and surgical units helps to decompress patient flow and capacity issues impacting EDs, but infrastructure challenges for providing high-quality delivery of care remain 5 …”

mentioning

confidence: 99%

“…Psychosocial services provided in these settings varied widely. An estimated 1 in 4 patients boarding in the ED required medication for aggressive behavior, and nearly 1 in 10 required physical restraints 4 …”

mentioning

confidence: 99%

See 2 more Smart Citations

Building a Nurse-Led Collaborative Care Delivery Model for Behavioral Health Patients Boarding on a Pediatric Medical Unit

Shannon,

Green,

Pires-Serisser

et al. 2023

JONA: The Journal of Nursing Administration

View full text Add to dashboard Cite

With the current global mental health crisis, hospitals have experienced an exponential increase in behavioral health patients boarding on medical and surgical units. Nursing leaders are challenged with adapting existing infrastructure to deliver safe high-quality care to this patient population. This article describes 1 medical center's nurse-led effort to improve safety and quality care experiences for pediatric behavioral health patients boarding on a medical unit and for the staff providing care.

show abstract

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Santillanes,

Foster,

Ishimine

et al. 2024

JACEP Open

View full text Add to dashboard Cite

Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

show abstract

Characteristics of children boarding in emergency departments for mental health conditions in a rural state

Cited by 4 publications

References 6 publications

Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns

Assessment of statewide initiative for children boarding in rural emergency departments with mental health concerns

Building a Nurse-Led Collaborative Care Delivery Model for Behavioral Health Patients Boarding on a Pediatric Medical Unit

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Contact Info

Product

Resources

About