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Emergency Department Length of Stay for Children and Adolescents with Mental Health Concerns :

April 8, 2021

The increasing prevalence of mental health issues is a major problem, made worse by the pandemic.

The increasing prevalence of mental health issues is a major problem, made worse by the pandemic. These problems are compounded by inadequate access to mental health care services. Unfortunately, many of our patients now seem to wait hours on end in the emergency department (ED) for evaluation and treatment of acute mental health problems.

How bad has this ED waiting period become? Nash et al (10.1542/peds.2020-030692) conducted a trend analysis of the National Hospital Ambulatory Medical Care Survey from 2005-2015 that is representative of almost 150 million ED visits. Of the 4.9% visits over the ten years for mental health concerns, there was a progressive increase from 16.3% to 24.5% for visits that lasted over 6 hours and from 5.3% to 12.7% for visits over 12 hours. Most concerning was the finding that if a child or teen was of Hispanic ethnicity, there was almost 3-fold odds increase of a visit being over 12 hours for their mental health problems. Interestingly, there was no difference in ED length of stay by payor type.

What is going on and why aren’t children and teens receiving equitable and timely access to pediatric mental health care in our EDs? The authors provide some thoughts in the discussion section of the paper, and even more insight is provided in an accompanying editorial by Drs. Krass and Doupnik (10.1542/peds.2020-049843) from the PolicyLab at the Children’s Hospital of Philadelphia. These two policy experts identify potential barriers contributing to prolonged length of stay. They also suggest prevention strategies as a means of overcoming those barriers to reduce the number of children requiring mental health services. One such strategy is better utilization of interpreter services. Family engagement is another important strategy to improve ED care.  

Of course, the pandemic might have worsened ED wait time for mental health services. By implementing even one of the suggestions made by the authors of this study and commentary, we might begin to show the improvements needed to reduce the growing mental health numbers crowding pediatric emergency facilities. Link to this study and commentary and learn what you can do to begin to reduce the numbers of young patients in EDs and the duration of their visits.

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