Child and Adolescent Mental Health Boarding Without Transfer

This letter reports a study initiated after concern about the large number of children boarding in the hospital during the COVID-19 pandemic. Children with behavioral or emotional complaints presented to the emergency department (ED). There the decision was made when indicated to either admit them to an inpatient medical unit for stabilization or board them in the ED while waiting for a bed to become available. The Joint Commission defines boarding as "the practice of holding patients in the emergency department or another temporary location after the decision to admit or transfer has been made" and recommends boarding duration of less than 4 hours.1 Mental health boarding reduces the number of ED and inpatient beds available for medical and surgical care while delaying psychiatric care.2.