A Novel Application of Statewide Emergency Department Data to Classify Behavioral Health Holds

Emergency department (ED) "boarding" for behavioral health occurs when patients remain in emergency rooms overnight due to a lack of available psychiatric beds. However, quantification of the problem and demographic characterization of affected populations have been limited and manual. When a patient stays in the ED awaiting either an inpatient psychiatric bed or community care, this is known as a behavioral health hold (BHH). Understanding of BHH requires statewide, 'real-time' data collection that does not widely exist.

Collaborators leveraged an existing syndromic surveillance system to compile ED data from across North Carolina into an executive BHH dashboard by developing a custom data extract, implementing a BHH case definition, and curating the data in a secure environment. Data come from 131 hospitals submitting ED visit data to NC DETECT, and the resulting extract includes patients with ED encounters lasting at least 24 hours for a behavioral health reason from November 2022 to November 2024.

The team implemented and evaluated multiple case definitions of BHH based on ICD-10 codes or keywords listed within the free-text encounter chief complaint. One case definition and four metrics were selected for use within a dashboard based on subject matter expert feedback. US Census Bureau data were used to create population denominators and estimate population rates, which are presented in an equity context.

This dashboard enabled data-driven funding and policy decisions for additional crisis stabilization resources, including Facility Based Crisis (FBC) facilities, Behavioral Health Urgent Care (BHUC) facilities, and Mobile Response and Stabilization Services.

A cross-departmental approach provided the necessary expertise for state departments of health to capitalize on an existing syndromic surveillance system to address a behavioral health policy need. This novel approach, encapsulated in a dashboard, places intelligence about the burden of BHH directly in the hands of policy makers.