Pediatric addictions and mental health boarding in emergency departments: a scoping review

Emergency departments (EDs) have seen growing rates of pediatric mental health presentations, a trend exacerbated by the COVID-19 pandemic. Many of these patients will 'board', remaining in the ED for prolonged periods of time while awaiting transfer to an inpatient bed. Boarding disproportionately impacts mental health patients and is associated with worse patient health outcomes and healthcare system inefficiency. The objective of this scoping review is to synthesize the extent and nature of evidence relating to pediatric mental health boarding, and to identify knowledge gaps.

Searches were conducted in MEDLINE, Embase, PsycINFO, and CINAHL for peer-reviewed literature involving mental health patients boarding in hospital EDs. Studies underwent eligibility screening for pediatric populations and data extraction by two reviewers. Results are reported per PRISMA-ScR guidelines.

Three thousand four hundred and fifty-eight studies were screened for title and abstract eligibility, 386 of which were assessed at full-text. Twenty-eight studies met inclusion criteria. Of these, 19 assessed variables impacting boarding, 18 quantified boarding duration or prevalence, 6 measured the impacts of boarding, 5 assessed interventions to mitigate boarding, and 4 provided consensus recommendations. Eighty-two percent of studies were published within the last 5 years and all are from the United States. Reported mean ED boarding times ranged from 5 to 54 h across 5 studies. Of 7 studies assessing the impact of COVID-19 on pediatric mental health boarding, all reported that COVID-19 was associated with increased boarding prevalence and/or duration.

An emerging body of literature on the burden and impacts of ED boarding among pediatric mental health patients suggests that boarding is a pressing concern in the delivery of pediatric emergency healthcare that has worsened since COVID-19. This is the most comprehensive evidence synthesis on pediatric mental health boarding to date, highlighting the impacts of boarding and the solutions studied to address this problem.