Changes in Behavioral Health Visits, Operations, and Boarding in a Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Mental and Behavioral Health

Background:

• Pediatric emergency department (PED) visits for mental and behavioral health concerns have significantly increased over the last decade.
• This rise presents operational challenges for PEDs managing patient flow and care timeliness.

Purpose of the Study:

• To investigate the relationship between the hours of care dedicated to pediatric mental and behavioral health patients and key performance indicators of PED throughput and timeliness.
• To quantify the impact of increased behavioral health care demands on emergency department operational metrics.

Main Methods:

• A retrospective, single-center, cross-sectional study analyzed PED encounters from 2010 to 2022.
• Negative binomial regression models were used to assess the association between monthly behavioral health care hours and operational metrics, controlling for overall ED volume.

Main Results:

• A total of 720,914 visits were included, with mental and behavioral health complaints accounting for 3.2% (22,901 visits).
• Mental and behavioral health visits increased by over 130% from 2010 to 2021, with a 1,483% rise in dedicated care hours.
• Increases in behavioral health care hours were significantly associated with worsening operational and care timeliness metrics.

Conclusions:

• The study indicates a significant negative association between increased mental and behavioral health care hours and PED throughput and timeliness.
• These findings underscore the substantial challenges PEDs face in integrating mental and behavioral health care while maintaining high-quality emergency services for all patients.