OBJECTIVES: Patients who present to the emergency department (ED) and require psychiatric hospitalization may wait in the ED or be admitted to a medical service because there are no available inpatient psychiatric beds. These patients are psychiatric "boarders." This study describes the extent of the boarder problem in a large, urban pediatric ED, compares characteristics of psychiatrically hospitalized patients with boarders, and compares predictors of boarding in 2 ED patient cohorts. METHODS: A retrospective cohort study was conducted in 2007-2008. The main outcome measure was placement into a psychiatric facility or boarding. Predictors of boarding in the present analysis were compared with predictors from a similar study conducted in the same ED in 1999-2000. RESULTS: Of 461 ED patient encounters requiring psychiatric admission, 157 (34.1%) boarded. Mean and median boarding duration for the sample were 22.7(SD, 8.08) and 21.18 hours, respectively. Univariate generalized estimating equations demonstrated increased boarding odds for patients carrying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of autism, mental retardation, and/or developmental delay (P = 0.01), presenting during the weekend (P = 0.03) or presenting during months without school vacation (P = 0.02). Suicidal ideation (SI) significantly predicted boarding status, with increased likelihood of boarding for severe SI (P = 0.02). Age, race, insurance status, and homicidal ideation did not significantly predict boarding in the 2007-2008 patient cohort, although they did in the earlier study. Systemic factors and SI predicted boarding status in both cohorts. CONCLUSIONS: Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.
OBJECTIVES:Patients who present to the emergency department (ED) and require psychiatric hospitalization may wait in the ED or be admitted to a medical service because there are no available inpatient psychiatric beds. These patients are psychiatric "boarders." This study describes the extent of the boarder problem in a large, urban pediatric ED, compares characteristics of psychiatrically hospitalized patients with boarders, and compares predictors of boarding in 2 ED patient cohorts. METHODS: A retrospective cohort study was conducted in 2007-2008. The main outcome measure was placement into a psychiatric facility or boarding. Predictors of boarding in the present analysis were compared with predictors from a similar study conducted in the same ED in 1999-2000. RESULTS: Of 461 ED patient encounters requiring psychiatric admission, 157 (34.1%) boarded. Mean and median boarding duration for the sample were 22.7(SD, 8.08) and 21.18 hours, respectively. Univariate generalized estimating equations demonstrated increased boarding odds for patients carrying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of autism, mental retardation, and/or developmental delay (P = 0.01), presenting during the weekend (P = 0.03) or presenting during months without school vacation (P = 0.02). Suicidal ideation (SI) significantly predicted boarding status, with increased likelihood of boarding for severe SI (P = 0.02). Age, race, insurance status, and homicidal ideation did not significantly predict boarding in the 2007-2008 patient cohort, although they did in the earlier study. Systemic factors and SI predicted boarding status in both cohorts. CONCLUSIONS: Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.
Authors: David C Sheridan; David M Spiro; Rongwei Fu; Kyle P Johnson; John S Sheridan; Alyssa A Oue; Wensi Wang; Rachel Van Nes; Matthew L Hansen Journal: Pediatr Emerg Care Date: 2015-08 Impact factor: 1.454
Authors: Luther G Kalb; Emma K Stapp; Elizabeth D Ballard; Calliope Holingue; Amy Keefer; Anne Riley Journal: Pediatrics Date: 2019-03-18 Impact factor: 7.124
Authors: Stephanie Ngo; Mohammad Shahsahebi; Sean Schreiber; Fred Johnson; Mina Silberberg Journal: J Behav Health Serv Res Date: 2018-10 Impact factor: 1.505
Authors: Sarah Kuriakose; Beryl Filton; Mollie Marr; Eugene Okparaeke; Paige Cervantes; Matthew Siegel; Sarah Horwitz; Jennifer Havens Journal: J Autism Dev Disord Date: 2018-12
Authors: Jason G Boudreaux; Kathleen A Crapanzano; Glenn N Jones; Thomas A Jeider; Vincent H Dodge; Marianne J Hebert; Jan M Kasofsky Journal: Community Ment Health J Date: 2015-09-11
Authors: Kathleen C Thomas; Hillary Owino; Sana Ansari; Leslie Adams; Julianne M Cyr; Bradley N Gaynes; Seth W Glickman Journal: Adm Policy Ment Health Date: 2018-07