We are in the midst of a staggering mental health crisis. Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. This podcast episode hosted by Brad Sobolewski (@PEMTweets) and co-authored by Dennis Ren (@DennisRenMD) is all about what we should consider when boarding children in the ED for mental health reasons. It is also the final episode in a 5 episode series focused on agitation in children and adolescents.

After listening to this episode you will be able to:

  • Identify some of the reasons why we are boarding so many children in the ED and which children are the highest priority
  • Describe the challenges these patients face as they await inpatient psychiatric care
  • Describe best practices and what we should be doing for them 
  • Discuss some of the stresses that these children place on the healthcare system, and possible alternative strategies.

This episode is a co-production of the Emergency Medical Services for Children Innovation and Improvement Center whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.

Other Episodes in the Agitation Series

Episode 1: Differentiating organic versus psychiatric causes of agitation and altered mental status | Supplementary EMDocs article

Episode 2: Non-pharmacologic management of agitated children | Supplementary EMDocs article

Episode 3: Pharmacologic management of the agitated child | Supplementary EMDocs article

Episode 4: Safe prehospital transport of the agitated child | Supplementary EMDocs article

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Agitation Episode 5: Management of the child with mental health problems who is boarded in the ED – Brad Sobolewski, MD, MEd & Dennis Ren, MD – PEM Currents: The Pediatric Emergency Medicine Podcast

Metabolic Disorders – PEM Currents: The Pediatric Emergency Medicine Podcast

This episode will help you better prepare for and manage children with inborn errors of metabolism in the Emergency Department. Consider it a supplement to what you remember from Biochemistry and the instructions on the family’s laminated care plan sheet. My special guest podcaster, Emily Groopman, is an actual Pediatric Geneticist in training and we […]
  1. Metabolic Disorders
  2. Vitamin K Deficient Bleeding (Hemorrhagic disease of the newborn)
  3. Cellulitis
  4. Laryngomalacia
  5. Meckel Diverticulum

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EMDocs Collaboration

EMDocs.net – the excellent Emergency Medicine site will also be contributing a supplementary article for each episode that will be posted each Friday following the release of the podcast episode. These articles will take another look at the content included in this episode.

Special thanks to Manpreet Singh, MD (@MprizzleER) for helping to put this collaboration together. 

EMSC IIC

To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center

Email km@emscimprovement.center

Follow on Twitter @EMSCImprovement

EMSC IIC: Pediatric Education and Advocacy Kit (PEAK): Agitation

PEAK Agitation resources

Disclaimer

The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov

To learn more about the Emergency Medical Services for Children Innovation and Improvement Center visit https://emscimprovement.center

Email km@emscimprovement.center

Follow on Twitter @EMSCImprovement

References

Fiona B. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. Leyenaar; Pediatric Mental Health Boarding. Pediatrics October 2020; 146 (4): e20201174. 10.1542/peds.2020-1174

AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health

Jennifer A. Hoffmann, Polina Krass, Jonathan Rodean, Naomi S. Bardach, Rachel Cafferty, Tumaini R. Coker, Gretchen J. Cutler, Matthew Hall, Rustin B. Morse, Katherine A. Nash, Kavita Parikh, Bonnie T. Zima; Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics March 2023; 151 (3): e2022057383. 10.1542/peds.2022-057383

Nordstrom K, Berlin JS, Nash SS, Shah SB, Schmelzer NA, Worley LLM. Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document. West J Emerg Med. 2019 Jul 22;20(5):690-695. doi: 10.5811/westjem.2019.6.42422. PMID: 31539324; PMCID: PMC6754202.

Cushing AM, Liberman DB, Pham PK, et al. Mental Health Revisits at US Pediatric Emergency Departments. JAMA Pediatr. 2023;177(2):168–176. doi:10.1001/jamapediatrics.2022.4885

Nash  KA, Zima  BT, Rothenberg  C,  et al.  Prolonged emergency department length of stay for US pediatric mental health visits (2005-2015).  Pediatrics. 2021;147(5):e2020030692. doi:10.1542/peds.2020-030692

Lo CB, Bridge JA, Shi J, Ludwig L, Stanley RM. Children’s Mental Health Emergency Department Visits: 2007-2016. Pediatrics. 2020 Jun;145(6):e20191536. doi: 10.1542/peds.2019-1536. Epub 2020 May 11. PMID: 32393605.

Parent/Professional Advocacy League: Best Practices: Pediatric Emergency Department Psychiatric Boarding

Kraft CM, Morea P, Teresi B, et al. Characteristics, Clinical Care, and Disposition Barriers for Mental Health Patients Boarding in the Emergency Department. American Journal of Emergency Medicine. Nov. 2020. Doi.org/10.1016/j.ajem.2020.11.021