524 - Multi-Institutional Emergency Department Assessment of Children Boarding for Mental Health Conditions in a Rural State

Poster Number: 524
Publication Number: 524.422

Taylor Marquis, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Nathan Schweitzer, Robert Larner, M.D., College of Medicine at the University of Vermont, Winooski, VT, United States; Mark Bisanzo, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Haley McGowan, Robert Larner, M.D., College of Medicine at the University of Vermont, Burlington, VT, United States; Ryan J. Sexton, Northeastern Vermont Regional Hospital, St. Johnsbury, VT, United States; Christian Pulcini, University of Vermont, Shelburne, VT, United States

Background: Large increases in pediatric presentations for acute mental health concerns during the COVID-19 pandemic and lack of infrastructure to address these concerns have resulted in high rates of emergency department (ED) boarding. Studies describing these epidemiological trends are emerging. No studies to our knowledge have investigated the patient and visit-level characteristics of acute mental health presentations among children. Therefore, our objective was to perform a multi-institutional assessment of children boarding in EDs across a rural state for mental health conditions.

Objective: Our objective was to perform a multi-institutional assessment of children boarding in EDs across a rural state for mental health conditions.

Design/Methods: Through a multi-disciplinary team of key stakeholders, we developed and piloted a chart review assessment tool to guide designated hospital site directors. Data was collected for pediatric patients (ages 1-17 years old) boarding in EDs (defined as stay >24 hours) across 11 hospitals (4 general and 7 critical access) in a rural state. Descriptive statistics were utilized to summarize findings, in addition to analysis of variance.

Results: Our sample included 294 patients who were primarily white (n=266, 92.7%), age 13-17 years (n=217, 73.8%), and publicly insured (n=226, 78.5%). Among our study population, 83.2% (n=242) had a previously diagnosed mental health condition, and 67.7% (n=191) were previously engaged in mental health treatment. The mean boarding time was 4.01 days (95% CI 3.66-4.35) and there was no significant difference in mean boarding times across EDs. While boarding, 6.3% (n=15) of patients were administered intramuscular medication, and 4.2% (n=12) were placed in physical restraints. Most children presented with suicidal ideation or a suicide attempt (n=175, 59.5%), which were also the most common disposition diagnoses (n=135, 45.9%).Conclusion(s): Through this statewide collaborative study, we report the individual and visit-level characteristics of children boarding in general and critical access EDs for mental health conditions in a rural state. Our data highlights the severity of mental health conditions among the pediatric population despite many receiving outpatient treatment, as well as prolonged boarding times in all types of EDs. Lack of diversity in the sample size precluded further meaningful investigation of disparities. Collaborative investigation is needed to further elicit differences in individual and visit-level characteristics of children boarding in the ED for mental health conditions.