The burden of mental and behavioral health visits to the pediatric ED: A 3‐year tertiary care center experience

Abstract

BackgroundThe shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety‐nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH‐related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate.MethodsWe reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi‐square (χ2), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission.ResultsOf 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), overdose/poisoning, and substance use (18.8%), and agitation/aggression (10.7%). Median EDLOS was 5.3 hr, average admission rate was 26.3%, with 20.7% boarding in the ED for >10 hr. Independent predictors of admission include depression (pOR: 1.5, CI: 1.3–1.7), bipolar disorder (pOR: 3.5, CI: 2.4–5.1), overdose/substance use disorder (pOR: 4.7, CI: 4.0–5.6), psychosis (pOR: 3.3, CI: 1.5–7.3), agitation/aggression (pOR: 1.8, CI: 1.5–2.1), and ADHD (pOR: 2.5, CI: 2.0–3.0). Principal independent driver of prolonged EDLOS was patient admission/transfer status (pOR: 5.3, CI: 4.6–6.1).ConclusionsGiven the study results, MBH‐related PED visits, ED length‐of‐stay, and admission rates continue to rise even in recent years. PEDs lack the resources and capability to provide high‐quality care for the increasing population of children with MBH needs. Novel collaborative approaches and strategies are urgently needed to find lasting solutions.