Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005–2015)

Abstract

BACKGROUND AND OBJECTIVES: Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non–mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS: We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005–2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS: From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non–mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69–4.44); there was no difference in LOS by payer type. CONCLUSIONS: The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda

“…Nash et al ( 2021 ) recently focused on the issue of prolonged ED stays, analyzing 2005 to 2015 data in 36,125 records from the National Hospital Ambulatory Medical Care Survey. During that 11-year period, the rates of pediatric ED mental health visits greater than six hours in length increased from 16.3% of all visits to 24.6%, while lengths of stay for non-mental health visits remained essentially unchanged.…”

“…The authors found that increased lengths of stay correlated with patient dissatisfaction, ED discharge without being seen by a physician, and increased costs of patient monitoring by ED medical and security staff. Nash et al (2021) recently focused on the issue of prolonged ED stays, analyzing 2005 to 2015 data in 36,125 records from the National Hospital Ambulatory Medical Care Survey. During that 11-year period, the rates of pediatric ED mental health visits greater than six hours in length increased from 16.3% of all visits to 24.6%, while lengths of stay for non-mental health visits remained essentially unchanged.…”

The kids are not alright

“…This mental health crisis began before the COVID‐19 pandemic 3 but has only worsened in the wake of its resulting social isolation. During the pandemic, suicide hotlines had a 1000% increase in call volumes 4 .…”

“…A patient in the throes of psychosis or suicidality needs a therapeutic milieu, not one that interrupts their daily routine, 2 disconnects them from their existing support networks, and is punctuated by the incessant clangs of bedside monitors and the hubbub of code teams. These environments are not therapeutic 3 for young infants with fevers, let alone for teenagers battling suicidality and eating disorders. In fact, for these reasons, we suspect that many of our patients’ inpatient “behavioral escalations” are in fact triggered by their hospital environment, which may contribute to the 300% increase in the number of pharmacological restraints used during mental health visits in the ED over the past 10 years 9 …”

An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

“…Health inequities-disparities that are unfair, unjust, avoidable, and unnecessary-are ubiquitous among pediatric populations. 1 Health inequities among Black and Hispanic children are well documented in the literature [1][2][3][4][5][6][7][8][9][10][11][12] and are often inappropriately attributed to underlying genetic differences. However, race is a social construct and has no biological basis.…”