Effects of Psychiatric Inpatient or Residential Care on Service Use After Psychiatric Emergency Department Boarding

Children and adolescents with mental health concerns commonly board in emergency departments (EDs), but not all receive psychiatric inpatient or residential care. The authors estimated the impact of admission to psychiatric inpatient or residential programs versus ED discharge on service utilization after multiple days in the ED.

The authors conducted a retrospective analysis of 2016-2019 Medicaid claims for youths ages 5-17 years across Massachusetts with mental health-related ED visits and 2-7 midnights in the ED. Admitted and discharged youths were matched on demographic characteristics, diagnostic group, day, month, and year of ED arrival, previous service utilization, and boarding length. Outcomes included mental health-related ED visits, psychiatric inpatient admissions, outpatient mental health visits, and primary care visits at 7, 30, and 180 days after ED discharge.

Among 2,664 youths with ED visits, 53% were male, and 59% were ages 13-17 years. Common diagnoses included mood disorders (30%), attention-deficit or disruptive disorders (23%), and suicidality or self-injury (16%). Overall, 43% were admitted to psychiatric inpatient or residential treatment. In the matched-sample analyses, admission reduced ED returns by 11 percentage points (pp) at 7 days (95% CI=-13 to -8 pp) and 30 days (95% CI=-14 to -7 pp), and by 5 pp at 180 days (95% CI=-10 to 0 pp). Admitted youths were less likely to be readmitted to inpatient psychiatry within 7 and 30 days. Outpatient mental health follow-up varied little.

Psychiatric inpatient or residential care after psychiatric ED boarding reduced rates of ED returns and psychiatric inpatient admissions.