529 - The Kids Are Not All Right: Behavioral Health Boarding in the Inpatient Medical Setting

Poster Number: 529
Publication Number: 529.422

Patricia A. Stoeck, Boston Children's Hospital, Boston, MA, United States; Chase R. Parsons, Harvard Medical School, Boston, MA, United States; Jonathan Hron, Boston Children's Hospital, Boston, MA, United States; Jayme L. Wilder, Boston Children's Hospital, Boston, MA, United States; Marcella Luercio, Boston Children's Hospital, Arlington, MA, United States; Patricia Ibeziako, Harvard Medical School, Boston, MA, United States; Kate E. Humphrey, Boston Children's Hospital, Vero Beach, FL, United States; Jonathan Mansbach, Boston Children's Hospital, Boston, MA, United States

Background: During the COVID-19 pandemic, there has been an increased number of children with behavioral health (BH) disorders seeking emergent crisis intervention, including children who require boarding on medical wards to await BH placement. It remains unclear if children boarding during the COVID-19 pandemic differ from pre-pandemic boarding children.
 

Objective: To characterize differences between COVID-19 and pre-COVID-19 BH boarding cohorts, including pharmacologic and physical restraints.

Design/Methods: We conducted a cross-sectional study of patients discharged from the Pediatric Hospital Medicine (PHM) service at a quaternary children’s hospital with a primary diagnosis of a BH disorder by comparing two time-based cohorts: 1) the COVID-19 cohort (50 weeks after initiation of the Massachusetts State of Emergency orders), and 2) the pre-COVID-19 cohort (50 weeks prior to these orders). We queried our enterprise data warehouse to characterize these children and their hospitalizations, including median hospital length of stay (LOS), primary diagnoses, and illness severity score. We identified pharmacologic and physical restraints from orders placed in the electronic health record. We then analyzed differences in cohorts using chi-square analysis.

Results: There were significantly more BH boarding patients in the COVID-19 cohort (n=412) than the pre-COVID-19 cohort (n=288) (p < 0.0001;Table). Median LOS was longer for BH boarding patients in the COVID-19 cohort (9.0 [IQR: 5.5-15.2] vs. 6.2 [IQR: 4.2-9.6] days). There were no significant differences in patient sex, race/ethnicity, or insurance type. Most common primary psychiatric diagnoses were significantly different in the COVID-19 cohort (p=0.01), with a higher proportion of patients admitted with anxiety and intentional ingestions. Although there were no differences in illness severity scores, fewer restraints were required in the COVID-19 cohort, both in overall number (488 vs. 527 events) and per LOS (0.08 vs. 0.13 events per LOS).Conclusion(s): BH boarding hospitalizations increased during the COVID-19 pandemic, especially for anxiety and intentional overdoses. Interestingly, despite higher numbers of patients, there was a reduction in total restraint number and per LOS, likely reflecting increased number of suicidal patients admitted for ingestions during this period, as they are less likely to require restraints. The greater volume of patients cared for on inpatient pediatric wards requires greater resource utilization and staff training (eg. de-escalation techniques) to ensure safety and merits follow-up study.
Characteristics of Pediatric Hospital Medicine Hospitalizations for Behavioral Health Boarding During and Before the COVID-19 Pandemic