Pediatric Mental Health Boarding in US Emergency Departments, 2018-2022

Jennifer A. Hoffmann, Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Ashley A. Foster, Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
Christopher J. Gable, Division of Emergency Medicine, Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine, Washington, District of Columbia, USA.
Kristen E. Carlin, Biostatistics, Epidemiology and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington, USA.
Alba Pergjika, Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Kimberly Burkhart, Division of Developmental-Behavioral, Pediatrics and Psychology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Theresa R. Schultz, Division of Emergency Medicine and Trauma Center, Children's National Hospital, Washington, District of Columbia, USA.
Sara Mullins, Mental Health Domain, Pediatric Pandemic Network, Denver, Colorado, USA.
Desiree Edemba, Division of Emergency Medicine, Department of Pediatrics, Center for Translational Research, Children's National Hospital, Washington, District of Columbia, USA.
Mohsen Saidinejad, The Lundquist Institute for Biomedical Innovation at Harbor UCLA, Los Angeles, California, USA.

Document Type

Journal Article

Publication Date

8-1-2025

Journal

Journal of the American College of Emergency Physicians open

Volume

6

Issue

4

DOI

10.1016/j.acepjo.2025.100180

Keywords

adolescent; boarding; child; emergency service; hospital; mental health

Abstract

OBJECTIVES: Children awaiting psychiatric hospitalization in the emergency department (ED) may experience prolonged boarding when no appropriate bed is available. Many recent studies of pediatric mental health boarding have focused on children's hospitals. Thus, we aimed to determine characteristics associated with boarding among pediatric mental health ED visits in a nationally representative sample. METHODS: This retrospective cross-sectional study examined mental health ED visits by children 5 to 17 years old using the 2018-2022 National Hospital Ambulatory Medical Care Survey, which uses probability sampling to generate national estimates. Survey-weighted multivariable logistic regression examined the association between visit characteristics and boarding, defined as visit length ≥12 hours. RESULTS: Of 5,900,704 estimated pediatric mental health ED visits nationally (42.9% 15-17 years old, 56.4% female), 25.2% resulted in admission or transfer, and, of those, 32.1% had length ≥12 hours. Adjusted odds radio (aOR) of boarding were lower for visits by 10 to 14-year-olds (aOR, 0.19; 95% CI: 0.05, 0.70) than 15- to 17-year-olds, for visits by patients identifying as non-Hispanic other (aOR, 0.06; 95% CI: 0.01, 0.72) than non-Hispanic White, for visits with private insurance (aOR, 0.31; 95% CI: 0.10, 0.95) relative to public insurance, and for visits on weekends (aOR, 0.27; 95% CI: 0.08, 0.91) compared with weekdays. CONCLUSION: Approximately 1 in 3 pediatric mental health ED visits resulting in admission or transfer exceeded 12 hours. Differences in boarding by race, ethnicity, and insurance type reflect inequities in access to psychiatric services. To reduce ED boarding, attention is needed to improve children's access to mental health services across the care continuum.

Department

Pediatrics

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