Changes in Behavioral Health Visits, Operations, and Boarding in a Pediatric Emergency Department - 27/11/24
, Michael C. Monuteaux, ScD a, b, c, Caitlin Kent, MHA c, Rebekah Mannix, MD, MPH a, b, c, Andrew Miller, MD a, b, c, Ashley Marchese, MD a, b, c, Jason Levy, MD a, b, cAbstract |
Study objective |
Over the past decade, there has been a dramatic increase in pediatric emergency department (PED) visits seeking mental and behavioral health care. We aimed to determine the relationship between hours of care devoted to patients with mental and behavioral health complaints and markers of PED throughput and timeliness.
Methods |
We performed a retrospective, single-center, cross-sectional study of PED encounters between 2010 and 2022. We reported effect of care for patients with mental and behavioral health complaints on operational metrics, including 4 throughput metrics and 3 care metrics (eg, vital signs within 30 minutes of arrival or left without being seen rates). We estimated a series of negative binomial regression models with the monthly count of the given metric as the dependent variable and monthly ED volume as the offset.
Results |
We included a total of 720,914 visits over the study period, of which 22,901 (3.2%) were mental and behavioral health complaints. The total number of mental and behavioral health visits increased over the study period, from 1,113 in 2010 to 2,554 in 2021, whereas the median monthly behavioral health care hours showed a 1,483% increase. All outcomes worsened as behavioral health care hours increased in both operational and care categories.
Conclusion |
In our single-center study, the increase in mental and behavioral health visits and hours of care was associated with significantly worsened PED throughput and timeliness of care metrics. This relationship highlights the challenges that PEDs face in caring for mental and behavioral health patients while simultaneously providing high-quality care to patients with acute nonmental and behavioral health emergencies.
Le texte complet de cet article est disponible en PDF.Keywords : Pediatric boarding, Mental health, Behavioral health, Mental health crisis
Plan
| Please see page XX for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Kathy N. Shaw, MD, MSCE. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: JH and JL conceived the study, performed interpretation of data, wrote the initial draft of the manuscript, and contributed substantially in subsequent drafts of the manuscript. MM and CK obtained the data, performed data analysis, and created included tables and figures. RM, AM, and AM provided critical interpretation of data and helped draft multiple revisions of the manuscript. All authors contributed substantially to various revisions of the manuscript. JH takes responsibility for the manuscript as a whole. |
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| Data sharing statement: The entire deidentified data set, data dictionary and analytic code for this investigation are available on request, from the date of article publication by contacting Joel Hudgins, MD, MPH at joel.hudgins@childrens.harvard.edu. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have declared that no competing interests exist. |
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| Presentation information: Our study was presented at Pediatric Academic Societies Meeting, Denver, CO, April 23, 2022. |
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