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

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.

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.

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.

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.