Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders

Bowden, Cadence F.; True, Gala; Cullen, Sara; Pollock, Miranda; Worsley, Diana; Ross, Abigail M.; Caterino, Jeffrey M.; Olfson, Mark; Marcus, Steven C.; Doupnik, Stephanie K.

doi:10.1016/j.annemergmed.2021.04.025

Cited by 14 publications

(7 citation statements)

References 42 publications

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“…In addition to the paucity of data on efficacy of suicide prevention interventions, many EDs lack resources 96 to provide these interventions. Payment is variable; insurance companies do not reimburse all billing codes 97 .…”

Section: Discharge Planningmentioning

confidence: 99%

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Santillanes,

Foster,

Ishimine

et al. 2024

JACEP Open

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Suicide is a leading cause of death among youth, and emergency departments (EDs) play an important role in caring for youth with suicidality. Shortages in outpatient and inpatient mental and behavioral health capacity combined with a surge in ED visits for youth with suicidal ideation (SI) and self‐harm challenge many EDs in the United States. This review highlights currently identified best practices that all EDs can implement in suicide screening, assessment of youth with self‐harm and SI, care for patients awaiting inpatient psychiatric care, and discharge planning for youth determined not to require inpatient treatment. We will also highlight several controversies and challenges in implementation of these best practices in the ED. An enhanced continuum of care model recommended for youth with mental and behavioral health crises utilizes crisis lines, mobile crisis units, crisis receiving and stabilization units, and also maximizes interventions in home‐ and community‐based settings. However, while local systems work to enhance continuum capacity, EDs remain a critical part of crisis care. Currently, EDs face barriers to providing optimal treatment for youth in crisis due to inadequate resources including the ability to obtain emergent mental health consultations via on‐site professionals, telepsychiatry, and ED transfer agreements. To reduce ED utilization and better facilitate safe dispositions from EDs, the expansion of community‐ and home‐based services, pediatric‐receiving crisis stabilization units, inpatient psychiatric services, among other innovative solutions, is necessary.

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Section: Discharge Planningmentioning

confidence: 99%

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Santillanes,

Foster,

Ishimine

et al. 2024

JACEP Open

View full text Add to dashboard Cite

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“…[13][14][15] In particular, clinicians who self-report having inadequate training in mental health care skills experience elevated stress levels when there is a lack of psychiatric hospital beds for mental health boarding patients. [16][17][18] To inform acute care hospital ED and inpatient medical unit leaders and clinical educators about workforce stressors associated Using an inductive approach, a codebook was created based on both a priori from previous work and emerging themes. 19,20 Interviews were coded by two master's level researchers (Diana Worsley and Cadence Bowden).…”

Section: Introductionmentioning

confidence: 99%

“…When caring for patients with these complex needs in general medical EDs and inpatient units, clinicians experience secondhand trauma, moral injury, and job dissatisfaction 13–15 . In particular, clinicians who self‐report having inadequate training in mental health care skills experience elevated stress levels when there is a lack of psychiatric hospital beds for mental health boarding patients 16–18 …”

Section: Introductionmentioning

confidence: 99%

Impact of mental health boarding on clinicians at a children's hospital: A qualitative analysis

Worsley,

Bowden,

Keating

et al. 2024

Journal of Hospital Medicine

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BackgroundThe child and adolescent mental health boarding crisis (i.e., prolonged stays in acute care hospitals for patients awaiting mental health treatment) continues to challenge acute care hospital staff and resources. We sought to understand clinician's experiences while caring for patients experiencing mental health boarding.MethodsWe conducted semistructured qualitative interviews with clinicians who care for patients experiencing mental health boarding in an acute care freestanding children's hospital with no inpatient psychiatric unit. We used an inductive approach to determine interview themes and major findings.ResultsThe study included 48 clinician participants from diverse specialties, including 13 social workers, 11 nurses, five psychiatric technicians, six pediatric residents, four attending pediatric hospitalists, four attending psychiatrists, one psychologist, and four other mental health specialists. We identified emergent themes in five domains: (1) frustrations with the mental healthcare system, (2) lack of training in mental healthcare skills, (3) feelings of helplessness, (4) ineffectiveness of medical model of care during mental health boarding, and (5) resilience and support factors.ConclusionsCaring for patients with mental health boarding has negative effects on clinicians, and health system efforts to prevent boarding could improve workforce retention and reduce burnout.

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“…Although the effect of caring for this population by pediatric hospitalists has not been studied, given the fact that children with primary behavior health issues are typically admitted to general medicine services when psychiatric services are not available, 13 it is probable that a similar risk exists for pediatric hospitalists. This association between burnout and care for pediatric patients with behavioral health complaints has been established for pediatric emergency medicine practitioners who reported moral distress at feeling ill equipped to care for this patient population even before the onset of COVID-19 14,15 . The situation has only intensified amidst the increased rates of burnout for these practitioners during the pandemic 16 .…”

mentioning

confidence: 97%

“…This association between burnout and care for pediatric patients with behavioral health complaints has been established for pediatric emergency medicine practitioners who reported moral distress at feeling ill equipped to care for this patient population even before the onset of COVID-19. 14 , 15 The situation has only intensified amidst the increased rates of burnout for these practitioners during the pandemic. 16 These deleterious effects are likewise felt by psychiatry practitioners who, although trained in the arena of mental health, are now tasked with seeing unprecedented volumes of pediatric patients in the inpatient setting due to the impact of COVID.…”

mentioning

confidence: 99%

A Clarion Call: COVID-19 and the Pediatric Behavioral Health Inpatient Crisis

Frush¹

2022

Southern Medical Journal

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Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders

Cited by 14 publications

References 42 publications

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Management of youth with suicidal ideation: Challenges and best practices for emergency departments

Impact of mental health boarding on clinicians at a children's hospital: A qualitative analysis

A Clarion Call: COVID-19 and the Pediatric Behavioral Health Inpatient Crisis

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