Children’s Hospital of Philadelphia (CHOP) researchers successfully reduced the number of youths needing to be admitted to psychiatric facilities through a stabilization protocol designed to address psychiatric boarding, the practice of maintaining patients with psychiatric emergencies in the Emergency Department (ED) or other temporary settings due to a lack of available inpatient psychiatric beds. The report was published recently in the journal Pediatrics.
America continues to face a youth mental health crisis leaving psychiatric facilities with limited inpatient beds and impacting the ability of families to access timely care. Given this predicament, a multidisciplinary team at CHOP launched a quality improvement (QI) project to address psychiatric boarding in the ED observation unit. The initiative focused on stabilizing patients, reducing psychiatric admissions and ensuring children received appropriate mental health support in the least restrictive setting. The project also prioritized family involvement and education to support ongoing care.
Researchers found the percentage of patients admitted to psychiatric facilities after boarding decreased from 65.7% (January 2019 through February 2021) to 49% during the intervention period (March 2021 through May 2022). In the pilot group specifically, admissions were reduced further to 22.6%. Overall, 75% of patients who participated in the stabilization protocol were discharged home compared with 31.4% in similar nonpilot cases during the same period.
“The success of this project underscores the importance of a multidisciplinary approach to psychiatric boarding,” said Jeremy Esposito, MD, MSEd, a senior study author and pediatric emergency medicine physician at Children’s Hospital of Philadelphia. “By creating a structured environment and improving both patient care and communication with families, we found innovative ways to manage psychiatric crises without relying heavily on inpatient or psychiatric facilities. This is especially critical in a healthcare system that often struggles with limited resources and long wait times for specialized care.”
Researchers noted other institutions may also benefit from implementing protocols tailored to their resources and patient population. CHOP has recently expanded its behavioral health services to address these critical issues, including the opening of its Behavioral Health and Crisis Center. It is comprised of a Crisis Response (CRC), a 24/7 walk-in facility that evaluates children 5 to 17 years old with immediate mental health needs along with inpatient care and treatment for specific ages. The facility is staffed with psychiatrists, psychologists, behavior analysts, creative art therapists, a clinical pharmacist, social workers, psychiatric nurses and psychiatric technicians.
Gunnison et al. “Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project.” Pediatrics. Online January 21, 2024. DOI: 10.1542/peds.2023-063262
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Children’s Hospital of Philadelphia (CHOP) researchers successfully reduced the number of youths needing to be admitted to psychiatric facilities through a stabilization protocol designed to address psychiatric boarding, the practice of maintaining patients with psychiatric emergencies in the Emergency Department (ED) or other temporary settings due to a lack of available inpatient psychiatric beds. The report was published recently in the journal Pediatrics.
America continues to face a youth mental health crisis leaving psychiatric facilities with limited inpatient beds and impacting the ability of families to access timely care. Given this predicament, a multidisciplinary team at CHOP launched a quality improvement (QI) project to address psychiatric boarding in the ED observation unit. The initiative focused on stabilizing patients, reducing psychiatric admissions and ensuring children received appropriate mental health support in the least restrictive setting. The project also prioritized family involvement and education to support ongoing care.
Researchers found the percentage of patients admitted to psychiatric facilities after boarding decreased from 65.7% (January 2019 through February 2021) to 49% during the intervention period (March 2021 through May 2022). In the pilot group specifically, admissions were reduced further to 22.6%. Overall, 75% of patients who participated in the stabilization protocol were discharged home compared with 31.4% in similar nonpilot cases during the same period.
“The success of this project underscores the importance of a multidisciplinary approach to psychiatric boarding,” said Jeremy Esposito, MD, MSEd, a senior study author and pediatric emergency medicine physician at Children’s Hospital of Philadelphia. “By creating a structured environment and improving both patient care and communication with families, we found innovative ways to manage psychiatric crises without relying heavily on inpatient or psychiatric facilities. This is especially critical in a healthcare system that often struggles with limited resources and long wait times for specialized care.”
Researchers noted other institutions may also benefit from implementing protocols tailored to their resources and patient population. CHOP has recently expanded its behavioral health services to address these critical issues, including the opening of its Behavioral Health and Crisis Center. It is comprised of a Crisis Response (CRC), a 24/7 walk-in facility that evaluates children 5 to 17 years old with immediate mental health needs along with inpatient care and treatment for specific ages. The facility is staffed with psychiatrists, psychologists, behavior analysts, creative art therapists, a clinical pharmacist, social workers, psychiatric nurses and psychiatric technicians.
Gunnison et al. “Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project.” Pediatrics. Online January 21, 2024. DOI: 10.1542/peds.2023-063262
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