Disparities in emergency department boarding: contrasting mental health and non-mental health patients.

Abstract

Objectives: Emergency department (ED) boarding is a major threat to timely and safe care delivery. Addressing boarding requires an understanding of which patient populations are significantly impacted to formulate solutions. Our objective was to evaluate the median ED boarding time of mental health compared to non-mental health patients.

Methods: We performed a database analysis using the National Ambulatory Care Reporting System data from 96 EDs from September 1, 2018, to September 30, 2023. International Classification of Diseases 10th Revision codes were used to define mental health and non-mental health subgroups for all patients admitted from the ED who were greater than 18 years old. Boarding was defined as the elapsed time between the admission decision to when patients departed the ED. Descriptive statistics summarized ED visit characteristics and median (IQR) boarding time throughout three study periods. An interrupted time series analysis evaluated boarding trends to account for COVID-19 variation.

Results: During the study period, 887,494 patients were admitted from an ED with mental health (113,209; 13%) or non-mental health (774,285; 87%) diagnoses. The mental health subgroup was younger, with a median age of 40, and predominantly male (57.1%). The median (IQR) boarding time for mental health patients was 120% longer (282 min (79-1113)) compared to non-mental health (128 min (58-420)). When comparing the initial and final study periods, mental health patient boarding increased by 76% (199 min), and non-mental health patient boarding increased by 24% (29 min).

Conclusion: This is the most extensive Canadian study comparing ED boarding for mental health and non-mental patients. The results demonstrate that mental health patients experience disproportionately longer ED boarding compared to other patient presentations, and the trend remains consistent over time. This emphasizes the need to address inequities in resourcing inpatient beds and adjust the current care model for mental health patients.