East Montgomery Times

Researchers at the Children's Hospital of Philadelphia (CHOP) have developed a new protocol that successfully reduces the number of youths needing admission to psychiatric facilities. This protocol addresses psychiatric boarding, where patients with psychiatric emergencies remain in emergency departments due to a shortage of inpatient beds. The findings were published in the journal Pediatrics.

The United States is facing a youth mental health crisis, leading to limited availability of inpatient beds and affecting families' access to timely care. In response, CHOP's multidisciplinary team initiated a quality improvement project targeting psychiatric boarding within the emergency department observation unit. The project's goals included stabilizing patients, reducing admissions, and ensuring children received appropriate mental health support in less restrictive settings while involving families in ongoing care.

Results showed a decrease in the percentage of patients admitted to psychiatric facilities after boarding from 65.7% between January 2019 and February 2021 to 49% during March 2021 through May 2022. Specifically, within the pilot group, admissions dropped further to 22.6%. Overall, 75% of participants in the stabilization protocol were discharged home compared to 31.4% in nonpilot cases during the same period.

"The success of this project underscores the importance of a multidisciplinary approach to psychiatric boarding," said Jeremy Esposito, MD, MSEd, senior study author and pediatric emergency medicine physician at CHOP. "By creating a structured environment and improving both patient care and communication with families, we found innovative ways to manage psychiatric crises without relying heavily on inpatient or psychiatric facilities."

Researchers suggest that other institutions could benefit from implementing protocols tailored to their resources and patient populations. CHOP has expanded its behavioral health services by opening its Behavioral Health and Crisis Center, which includes a Crisis Response Center for immediate evaluation of children aged 5-17 years with mental health needs alongside inpatient care for specific ages. The facility is staffed with psychiatrists, psychologists, behavior analysts, creative art therapists, clinical pharmacists, social workers, psychiatric nurses and technicians.

Gunnison et al.'s study titled "Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project" was published online on January 21st.