Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project

Area of Science:

• Quality Improvement in Healthcare
• Pediatric Psychiatry
• Emergency Medicine

Background:

• Psychiatric boarding affects youth, families, and healthcare systems.
• Emergency department (ED) observation units often experience patient boarding.
• Addressing psychiatric boarding is crucial for effective patient care.

Purpose of the Study:

• To implement a quality improvement (QI) project to reduce psychiatric boarding.
• To stabilize youth patients in the ED observation unit.
• To decrease the rate of psychiatric facility admissions for boarding patients.

Main Methods:

• A multidisciplinary team developed a stabilization protocol.
• The protocol included enhanced coping strategies, family communication, psychoeducation, and safety planning.
• Implementation involved additional staffing, structured activities, and EHR enhancements.

Main Results:

• Psychiatric facility admissions decreased from 65.7% to 49.0% during the intervention period.
• Pilot encounters showed a significant reduction in psychiatric admissions (22.6% vs 58.2%).
• Pilot encounters were more likely to result in discharge home (75.0% vs 31.4%).

Conclusions:

• The QI project successfully reduced patient transfers to inpatient psychiatric care.
• Medical hospitals can implement innovative strategies to improve care for boarding patients.
• This initiative demonstrates a creative approach to managing psychiatric boarding in EDs.