Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access

IF 2.7 4区 心理学 Q2 PSYCHIATRY Journal of the Academy of Consultation-Liaison Psychiatry Pub Date : 2024-09-01 DOI:10.1016/j.jaclp.2024.04.001
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Abstract

Background

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. Objectives: We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis.

Methods

Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October–December 2021 and one year later (October–December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units.

Results

One year after full intervention implementation (October–December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October–December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]).

Conclusions

The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.
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减少儿童精神健康寄宿和增加急症护理机会
近年来,美国儿科心理健康寄宿人数明显增加,青少年被安置在急诊科或内外科住院部,等待接受精神病治疗。我们旨在评估一家大型三级儿科医院在全国性儿科精神健康危机期间采取干预措施以减少寄宿人数并改善急诊精神科服务的结果。寄宿干预措施包括扩大精神科住院病床、增聘员工以加强危机稳定服务,以及在急诊科和内外科住院病房为等待安置的寄宿患者启动治疗。在 2021 年 10 月至 12 月干预措施开始实施期间和一年后(2022 年 10 月至 12 月),通过对精神健康突发事件患者的回顾性审查进行了事后评估。纳入标准为在研究期间出现精神健康相关紧急情况的年龄≤17 岁的患者。排除标准是年龄≥18 岁的患者和/或入院时间超过 100 天、等待长期安置的患者。主要结果是平均寄宿时间(LOB)。次要结果是在医院急性精神病科的平均住院时间(LOS)。干预措施全面实施一年后(2022 年 10 月至 12 月),与 2021 年 10 月至 12 月相比,出院后接受高级护理(如住院、急性住院)和中级护理(如部分住院、居家危机稳定计划)的寄宿患者的平均寄宿时间减少了 53%(4.3 天 vs 9.1 天,< 0.0001)。此外,所有24小时急诊精神病治疗项目的平均住院日减少了27%(20.0天 vs 14.6天,=0.0002),更多患者能够获得此类项目(265/54.2% vs 221/41.9%,<0.0001)。在这两年中,有攻击性行为的青少年的住院时间(2.93 ± 1.15,95% CI [2.23,3.87])比没有攻击性行为的青少年长193%,而曾入住精神病院的青少年的住院时间(1.88 ± 1.11,95% CI [1.54,2.30])比没有入住精神病院的青少年长88%。目前的研究表明,经过综合干预后,需要接受急性精神病治疗的青少年的等待时间缩短,获得治疗的机会增加,同时也凸显了有攻击性行为的青少年在安置方面所面临的挑战。我们建议儿科医院采取行动,投入足够的急诊精神科资源,以解决儿科精神健康寄宿问题。
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来源期刊
CiteScore
5.80
自引率
13.00%
发文量
378
审稿时长
50 days
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