Impact of boarding pediatric psychiatric patients on a medical ward.
OBJECTIVE
Psychiatric disorders account for an increasing number of pediatric hospitalizations. Due to lack of psychiatric beds, patients on involuntary psychiatric holds may be admitted to medical units. Our objectives were to evaluate the rate of admission of psychiatric patients to a medical unit, psychiatric care provided, and estimated cost of care.


METHODS
The study involved retrospective chart review of all patients on involuntary psychiatric holds presenting to 1 pediatric emergency department from July 2009 to December 2010. We determined the rate of admission to a medical unit, the rate of counseling or psychiatric medication administration, and the estimated cost of nonmedical admissions (boarding) of patients on the medical unit.


RESULTS
A total of 555 (50.1%) of 1108 patients on involuntary psychiatric holds were admitted to the pediatric medical unit. The majority (523 [94.2%]) were admitted for boarding because no psychiatric bed was available. Thirty-two (6.1%) patients admitted for isolated psychiatric reasons had counseling documented, and 105 (20.1%) received psychiatric medications. Patients admitted to an affiliated psychiatric hospital were significantly more likely to receive counseling and medications. Psychiatric patients were boarded in medical beds for 1169 days at an estimated cost of $2 232 790 or $4269 per patient over the 18-month period.


CONCLUSIONS
We found high admission rates of patients on involuntary psychiatric holds to a pediatric medical unit with little psychiatric treatment in 1 hospital. Further research in other centers is required to determine the extent of the issue. Future studies of longer term outcomes (including readmission rates and assessments of functioning) are needed.
Department of Emergency Medicine, Los Angeles County + USC Medical Center, Keck School of Medicine, University of Southern California at Los Angeles, Los Angeles, California; and.
Ilene
I
Claudius
J Joelle
JJ
Donofrio
Chun Nok
CN
Lam
Genevieve
G
Santillanes
D002648:Child; D003376:Counseling / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D006742:Hospital Bed Capacity; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies
aggression; depression; psychiatry; suicide