Understanding the Boarding Crisis in Pediatric Psychiatry
The recent research article, "Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping," highlights a critical issue in pediatric mental health care: the boarding crisis. This crisis involves children and adolescents waiting in emergency departments (EDs) for extended periods due to a lack of available psychiatric placements. The study, conducted at a northeastern children's hospital, utilized patient journey mapping to explore the experiences of healthcare providers and identify systemic barriers and facilitators in the boarding process.
Key Findings from the Research
The research revealed a significant increase in the number of pediatric patients boarding in EDs, with a three-fold rise over three years and a 60% increase in average boarding time. The study identified three stages in the boarding process: Initial Evaluation, Admission to Board, and Discharge. Each stage presented unique challenges and opportunities for improvement.
- Initial Evaluation: Effective coordination between medical and psychiatric teams and the use of standardized assessments were bright spots. However, extended wait times and inadequate physical spaces were major pain points.
- Admission to Board: Strong team communication was a positive aspect, but the lack of appropriate beds and the stigma surrounding mental health posed significant challenges.
- Discharge: The process was labor-intensive and often inefficient, with a lack of available psychiatric services and inadequate family support being major barriers.
Implications for Practitioners
For practitioners working with pediatric psychiatric patients, the insights from this study can guide improvements in care delivery. Here are some actionable steps based on the research findings:
- Enhance Staff Training: Providing training in de-escalation techniques and safety planning can empower non-psychiatric staff to better support patients.
- Improve Care Coordination: Implementing a centralized system for tracking available psychiatric services can streamline the discharge process and reduce wait times.
- Utilize Telehealth: Online interventions can offer interim support for patients and families while awaiting placement, providing psychoeducation and coping strategies.
Encouraging Further Research
The study underscores the need for continued research into systemic improvements in pediatric psychiatric care. Practitioners are encouraged to explore journey mapping and other qualitative methods to identify barriers and develop targeted interventions. By doing so, we can work towards reducing boarding times and improving outcomes for children and adolescents in psychiatric crises.
To read the original research paper, please follow this link: Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping.
