Reducing Behavioral and Mental Health Emergency Department Visits and Admissions

Pediatric emergency department (ED) visits and admissions for behavioral and mental health (BMH) concerns are rising nationally. Such encounters can be traumatic, with adverse clinical and financial consequences for patients and their families. We aimed to reduce excess ED visits and hospital admissions for patients at an urban primary care clinic exclusively serving adolescents. Specifically, we sought to decrease the BMH ED visit rate from 7.9 to 6.0 per 1000 patients per month and the BMH admission rate from 4.5 to 3.0 per 1000 per month.

We pursued this quality improvement (QI) initiative between 2019 and 2025. The population included patients aged 12 to 19 years within our Teen Health Center's clinical registry. Interventions addressing 7 key drivers (appropriate staff and space, knowledge and awareness of BMH resources, effective patient triage, reliable and standardized screening and assessment, optimal care coordination, optimal follow-up, and community outreach) were designed, tested, and implemented. The BMH ED visit and BMH admission rates (per 1000 patients per month) among the primary care population were tracked via statistical process control charts.

Over the improvement period, BMH ED visits decreased from 7.9 per 1000 per month to 5.9 (25% reduction). Admissions decreased from 4.5 per 1000 per month to 1.9 (58% reduction). This equates to around 10 fewer ED visits and around 11 fewer admissions per month for BMH concerns for patients in our primary care practice.

Implementing collaborative primary care with QI may improve BMH care for adolescents by reducing ED visits and admissions.