Factors associated with boarding and length of stay for pediatric mental health emergency visits

Hoffmann, Jennifer A.; Stack, Anne M.; Monuteaux, Michael C.; Levin, Romy; Lee, Lois K.

doi:10.1016/j.ajem.2018.12.041

Cited by 49 publications

(44 citation statements)

References 34 publications

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“…MH presentations are more likely to arrive out of business hours, be triaged as urgent, stay longer in ED and be admitted to hospital . Similar increases in presentations and length of stay (LOS) are reported in the USA …”

Section: Introductionmentioning

confidence: 68%

Children and adolescents with severe acute behavioural disturbance in the emergency department

Carison

Babl

Hill

et al. 2020

Emerg Medicine Australasia

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Objective: Mental health (MH) presentations to ED are increasing in children and adolescents. Little is known about patients with severe acute behavioural disturbance (ABD). We set out to describe patients with ABD severe enough to trigger an acute crisis team response in ED (termed 'Code Grey') and how they differ from other MH patients. Methods: Retrospective electronic medical record review of all ED patients with MH discharge codes at a tertiary children's hospital. We assessed the epidemiology and management of patients who triggered acute crisis team interventions (Code Grey) as proxy for severe ABD. We calculated the odds ratios (ORs with 95% confidence intervals) of key demographic factors compared to other MH patients. Results: During 2018, there were 85 347 ED presentations of which 1695 (2.0%) were related to MH diagnoses; 84 MH patients had 141 MH presentations triggering 204 Code Greys (26 patients triggered 59% of Code Greys). These patients had higher triage acuity (OR 12.6 [8.3-19.0]), stayed longer in ED (>12 h OR 8.2 [5.1-13.1]) and were more likely to be admitted (OR 2.0 [1.4-3.0]) compared with non-Code Grey MH presentations. Patients were physically (19.2%), mechanically (31.9%) or chemically restrained (37.6%). Eight different medication approaches were used as either a single agent or a combination of oral and/or intramuscular agents. Conclusions: Children and adolescents with severe ABD differ from other MH presentations and often require physical or chemical restraint. Anticipatory management plans may be valuable for repeat presenters.

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Section: Introductionmentioning

confidence: 68%

Children and adolescents with severe acute behavioural disturbance in the emergency department

Carison

Babl

Hill

et al. 2020

Emerg Medicine Australasia

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“…Each of these studies used different time thresholds to define boarding, ranging from 6 to 24 hours. 26,28,30 Wharff et al 31 applied a hybrid definition that included both a time-…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

“…Boarding in the ED was reported to occur in 23% to 58% of study-eligible youth with mental or behavioral health concerns, whereas inpatient boarding rates ranged from a low of 26% to a high of 49%. 23,26 In 6 studies, authors reported associations between patients' sociodemographic and clinical characteristics and mental health, with inconsistent findings. 22,23,[26][27][28]31 Younger age was associated with boarding in 3 studies, 23,27,28 whereas payer type was associated with boarding in 2 studies.…”

Section: Figurementioning

confidence: 99%

Pediatric Mental Health Boarding

McEnany

Ojugbele²,

Doherty

et al. 2020

Pediatrics

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CONTEXT: The growing prevalence of pediatric mental and behavioral health disorders, coupled with scarce psychiatric resources, has resulted in a substantial increase in the number of youth waiting in emergency departments (EDs) and medical units for inpatient psychiatric care. OBJECTIVE: To characterize the prevalence of pediatric mental health boarding and identify associated patient and hospital factors. DATA SOURCES: Medline and PsycINFO. STUDY SELECTION: All studies describing frequencies, durations, processes, outcomes, and/or risk factors associated with pediatric mental health boarding in youth #21 years of age. DATA EXTRACTION: Publications meeting inclusion criteria were charted by 2 authors and critically appraised for quality. RESULTS: Eleven studies met inclusion criteria; 10 were retrospective cohort studies and 9 were conducted at single centers. All of the single-center studies were conducted at children's hospitals or pediatric EDs in urban or suburban settings. Study sample sizes ranged from 27 to 44 328. Among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and 26% to 49% boarded on inpatient medical units. Average boarding durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. Risk factors included younger age, suicidal or homicidal ideation, and presentation to a hospital during nonsummer months. Care processes and outcomes were infrequently described. When reported, provision of psychosocial services varied widely. LIMITATIONS: Boarding definitions were heterogeneous, study sample sizes were small, and rural regions and general hospitals were underrepresented. CONCLUSIONS: Pediatric mental health boarding is prevalent and understudied. Additional research representing diverse hospital types and geographic regions is needed to inform clinical interventions and health care policy.

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“…Furthermore, it is common for this subpopulation to require high levels of intensive intervention (e.g., specialized school placements, psychopharmacology, and in‐home behavioral therapies), which often exceed what providers in community settings can offer [Joshi et al, ; Siegel et al, ]. It can also land individuals with ASD in emergency rooms that are ill‐equipped to handle them [Hoffmann, Stack, Monuteaux, Levin, & Lee, ] and necessitate costly psychiatric hospital care [Croen, Najjar, Ray, Lotspeich, & Bernal, ; Nayfack et al, ; Siegel & Gabriels, ]. Our use of an inpatient psychiatric population not only allowed us to enroll youth functioning poorly across domains who are underrepresented in research, but also provided a unique opportunity to study naturally unfolding aggression in a safe environment.…”

Section: Discussionmentioning

confidence: 99%

Predicting aggression to others in youth with autism using a wearable biosensor

et al. 2019

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Unpredictable and potentially dangerous aggressive behavior by youth with Autism Spectrum Disorder (ASD) can isolate them from foundational educational, social, and familial activities, thereby markedly exacerbating morbidity and costs associated with ASD. This study investigates whether preceding physiological and motion data measured by a wrist-worn biosensor can predict aggression to others by youth with ASD. We recorded peripheral physiological (cardiovascular and electrodermal activity) and motion (accelerometry) signals from a biosensor worn by 20 youth with ASD (ages 6-17 years, 75% male, 85% minimally verbal) during 69 independent naturalistic observation sessions with concurrent behavioral coding in a specialized inpatient psychiatry unit. We developed prediction models based on ridge-regularized logistic regression. Our results suggest that aggression to others can be predicted 1 min before it occurs using 3 min of prior biosensor data with an average area under the curve of 0.71 for a global model and 0.84 for person-dependent models. The biosensor was well tolerated, we obtained useable data in all cases, and no users withdrew from the study. Relatively high predictive accuracy was achieved using antecedent physiological and motion data. Larger trials are needed to further establish an ideal ratio of measurement density to predictive accuracy and reliability. These findings lay the groundwork for the future development of precursor behavior analysis and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression in ASD.Lay Summary: Unpredictable aggression can create a barrier to accessing community, therapeutic, medical, and educational services. The present study evaluated whether data from a wearable biosensor can be used to predict aggression to others by youth with autism spectrum disorder (ASD). Results demonstrate that aggression to others can be predicted 1 min before it occurs with high accuracy, laying the groundwork for the future development of preemptive behavioral interventions and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression to others in ASD.

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Factors associated with boarding and length of stay for pediatric mental health emergency visits

Cited by 49 publications

References 34 publications

Children and adolescents with severe acute behavioural disturbance in the emergency department

Children and adolescents with severe acute behavioural disturbance in the emergency department

Pediatric Mental Health Boarding

Predicting aggression to others in youth with autism using a wearable biosensor

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