Wednesday, February 19, 2020

Youth Who Stay in ED Overnight for Mental Health Problems Often Discharged Without Psychiatric Evaluation

Two-thirds of children and adolescents who had to stay in an emergency department (ED) for at least 24 hours with a mental health complaint had suicidal thoughts or behaviors, yet many did not receive a formal psychiatric evaluation by a psychiatrist with treatment recommendations, according to a report in JAMA Pediatrics.

Staying overnight in the emergency department without receiving care, known as boarding, is a significant problem related to the shortage of inpatient psychiatric beds. Erin O’Donnell, M.D., of the Division of Pediatric Emergency Medicine at Johns Hopkins University School of Medicine and colleagues analyzed data on 573 children and adolescents (average age of 14) who stayed at least 24 hours with a mental health complaint at one urban pediatric ED. Most of the patients were African American, resided within city limits, and had no long-term physical conditions.

On average, patients stayed in the ED for 54 hours. The most common chief complaints included suicidal ideation or suicidal attempt and behavior disorder. Many patients had a history of psychiatric problems, with only 74 (12.9%) having no previous psychiatric diagnosis. Nearly half of the patients also had a history of being seen in the ED for mental health concerns.

A total of 378 (66%) of the youth answered positively to suicide-screening questions. Yet only 295 (51.5%) received a formal psychiatric evaluation by a psychiatrist with treatment recommendations. A total of 97 patients (16.9%) for whom hospitalization was initially recommended were discharged home.

“Identifying that almost half of patients had prior mental health–related ED visits together with previous studies revealing that patients fail to receive care from mental health clinicians prior to ED presentation underscores the importance of improving access to outpatient services,” O’Donnell and colleagues wrote. “Given that a sizable portion of boarding patients were discharged home, further efforts are needed to optimize the therapeutic care delivered in the ED and to identify interventions aimed at preventing repeated crises.”

For more information, see the Psychiatric News article “Resource Document on ED Boarding Spells Out Best Practices.”

(Image: iStock/MJFelt)

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