40 - Medication burden for children with mental and behavioral health conditions in the pediatric emergency department

Poster Number: 40
Publication Number: 40.103

Ashley A. Foster, Massachusetts General Hospital, Boston, MA, United States; John J. Porter, Boston Children's Hospital, Boston, MA, United States; Michael C. Monuteaux, Boston Children's Hospital, Boston, MA, United States; joel Hudgins, Boston Children's Hospital, Boston, MA, United States

Background:
Children with mental and behavioral health (MBH) conditions are seeking emergency department (ED) care with increasing frequency and may experience significant challenges in the ED including limited access to mental health care and prolonged length of stay (LOS). Prolonged ED LOS exposes children to a possible increase in medication administration with a concomitant increase in the potential for medication error. There are limited data about medication burden in children with MBH symptoms during their ED visit.  

Objective:
To describe frequency of medications administered to children with MBH conditions in the ED and analyze changes over time for ED MBH visits with ≥1 medication administered.

Design/Methods: We performed a cross-sectional study examining ED visits from 9/2011-9/2021 with a primary MBH diagnosis in patients 3-21 years using the Pediatric Health Information System database. Visits that resulted in discharge, transfer, leaving against medical advice, and death were included, while those resulting in admission to the hospital were excluded as there is no way to ascertain location of medication administration. We calculated frequency of medication administration by the 10 most common MBH diagnostic groups by ICD-9 and ICD-10 codes, and the change in number of medications and LOS over time.
 

Results: Over the study period, there were 369,814 ED visits that met inclusion criteria. Of those, 93,370 (25.2%) were associated with an administered medication. The mean number of medications per visit was 0.62(Table 1). Among the top 10 diagnostic groups, visits with neurocognitive disorders were administered the highest mean medications per visit (1.27), while disruptive, impulse control and conduct disorders had the highest mean number of medications per visit (3.59) when restricted to visits with ≥1 medication administered (Table 2). For visits with ≥ 1 medication administered, with each one-year increase there was a 0.12 mean increase (95% CI 0.07-0.18) in number of medications administered and a 0.02 mean increase (in minutes; 95% CI 0.01-0.03) in LOS (Figure 1). Conclusion(s): Overall, for ED MBH visits with ≥ 1 medication administered, there was a significant increase in both mean number of medications administered and ED LOS over time. Rising medication administration may represent increasing severity of illness or evolving medical complexity, which has significant implications for both patients and required ED resources to ensure high quality care.
Table 1. Characteristics of visits with a primary mental and behavioral health (MBH) condition who received a medication in the emergency department (ED)
Table 2. Frequency of medication administration by top 10 mental and behavioral health diagnoses groupings