Who's Boarding in the Psychiatric Emergency Service?

Abstract

IntroductionWhen a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a “boarder.” The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described.MethodsWe electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student’s t-tests and multivariate regression.Results521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis.ConclusionBoarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients.

Factors associated with prolonged length of stay in the psychiatric emergency service

“…That being the case, these patients carry a significantly higher risk and are difficult to manage in any circumstances. The challenges are magnified in emergency settings due to the physical limitations and the lack of consistency in staffing [ 34 ].…”

“…In that study, prolonged LOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Another study was also conducted in the PES but used boarding as the primary outcome [ 34 ]. The study concluded that boarding was associated with referral by a party other than the patient, arrival on or just after the weekend, arrival in restraints, physical restraint or seclusion in the PES, referral for involuntary hospitalization, primary anxiety disorders or personality disorders, and tobacco use.…”

Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses

“…To that end, we found that 73% of transferred patients with a primary psychiatric diagnosis met the criteria for boarding. Other studies found that rates of boarding ranged from 9.7% to 27.5% (24, 36, 37); however, one survey found that greater than 30% of EDs board at least 75% of all patients (38). Our rate of boarding was likely high due to our sample characteristics (i.e.…”

Qualität der psychiatrischen (Krankenhaus-)Versorgung – Perspektiven?

“…Die Analyse der "Zugangskarrieren" von Notfallpatienten könnte hierbei den Anteil der Wirkungen durch die Fragmentierung und die Lücken des Versorgungssystems z. B. am Wochenende im Unterschied zu patientenbezogenen Faktoren sichtbar machen, wie es US-Autoren nachweisen konnten [4].…”