title: Psychiatric boarding incidence, duration, and associated factors in United States emergency departments.
abstract: BACKGROUND
  Boarding, especially among psychiatric patients, has been characterized as a significant cause of ED crowding, but no quantitative analysis has described boarding nationally. This study determines the incidence, duration, and factors associated with ED boarding in the United States.
  
  
  METHODS
  2008 National Hospital Ambulatory Medical Care Survey ED data were stratified by visit type (psychiatric vs. non-psychiatric), boarding status, and patient and hospital characteristics. Boarding was defined as a visit with an ED length of stay >6 hours, and boarding time as ED length of stay minus 6 hours. Pearson's chi-square tests describe hospital and patient characteristics stratified by boarding status. Multilevel multivariable logistic and linear regressions determine associations with boarding and boarding time.
  
  
  RESULTS
  While 11% of all ED patients boarded, 21.5% of all psychiatric ED patients boarded. Boarding was also more prolonged for psychiatric ED patients. Controlling for confounders, odds of boarding for psychiatric patients were 4.78 (2.63-8.66) times higher than non-psychiatric, and psychiatric patients boarded 2.78 (1.91-3.64) hours longer than non-psychiatric.
  
  
  CONCLUSIONS
  US EDs experienced high proportions and durations of boarding with psychiatric patients disproportionately affected. Additional research concerning mental health care services and legislation may be required to address ED psychiatric patient boarding.
authors.affiliation: San Francisco, CA. Electronic address: jason.nolan@ucsfmedctr.org.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Nolan
authors.affiliation: San Francisco, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fee
authors.affiliation: San Francisco, CA.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cooper
authors.affiliation: San Francisco, CA.
authors.forename: Sally H
authors.initials: SH
authors.lastname: Rankin
authors.affiliation: San Francisco, CA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Blegen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003441:Crowding; D004632:Emergency Medical Services / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012737:Sex Factors; D014481:United States; D055815:Young Adult
keywords: Boarding; Crowding; Emergency medical services; Mental health care; Patient flow