The Impact of Psychiatric Boarding in the Emergency Department: A Mixed-Methods Study

For pediatric patients requiring inpatient psychiatric admission, there is often a significant waiting period in the emergency department. In this mixed-methods pilot study, we explored the psychiatric boarding experience for pediatric patients and their guardians.

Patients (aged 10-17 years) awaiting inpatient psychiatric care and their guardians were recruited from November 2022 to June 2023 from the Children's and Psychiatric emergency departments at a large Midwestern academic medical center. Survey methodology was used to capture data including their subjective boarding experience, rating of their stress level, and their sleep quality.

Participants included youths (n = 41) and their guardians (n = 39). The youths had a mean (± SD) age of 14.5 (± 1.8) years and were predominately female (53.8%) and white (80.0%). Both youth (6.2 ± 2.8) and guardian (6.7 ± 2.7) self-reported stress levels were moderately high (10 being highest stress). Descriptive results suggested potential connections between receiving updates, anticipated boarding time, and stress. Qualitative feedback from patients and guardians included positive aspects (staff and food/drinks) and things they would recommend changing (environment, length of stay, and lack of communication). Most eligible participants who were approached (70.7%) consented to the study, and all enrolled youth completed at least 1 survey, indicating the feasibility of this method of research.

This study supports the concerns about the psychiatric boarding process. The survey methodology was feasible and pointed toward potential areas for intervention as well as future research, such as how physical plant alterations, expanded programming, and enhanced communication could affect the boarding experience.