title: Who's boarding in the psychiatric emergency service?
abstract: BACKGROUND
  When a psychiatric patient in the emergency department requires inpatient admission, but no bed is available, they may become a "boarder." The psychiatric emergency service (PES) has been suggested as one means to reduce psychiatric boarding, but the frequency and characteristics of adult PES boarders have not been described.
  
  
  METHODS
  We electronically extracted electronic medical records for adult patients presenting to the PES in an urban county safety-net hospital over 12 months. Correlative analyses included Student's t-tests and multivariate regression.
  
  
  RESULTS
  521 of 5363 patient encounters (9.7%) resulted in boarding. Compared to non-boarding encounters, boarding patient encounters were associated with diagnoses of a primary psychotic, anxiety, or personality disorder, or a bipolar manic/mixed episode. Boarders were also more likely to be referred by family, friends or providers than self-referred; arrive in restraints; experience restraint/seclusion in the PES; or be referred for involuntary hospitalization. Boarders were more likely to present to the PES on the weekend. Substance use was common, but only tobacco use was more likely associated with boarding status in multivariate analysis.
  
  
  CONCLUSIONS
  Boarding is common in the PES, and boarders have substantial psychiatric morbidity requiring treatment during extended PES stays. We question the appropriateness of PES boarding for seriously ill psychiatric patients.
authors.affiliation: University of Colorado School of Medicine, Department of Psychiatry, Denver, Colorado.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Simpson
authors.affiliation: University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington.
authors.forename: Jutta M
authors.initials: JM
authors.lastname: Joesch
authors.affiliation: University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington.
authors.forename: Imara I
authors.initials: II
authors.lastname: West
authors.affiliation: University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle, Washington.
authors.forename: Jagoda
authors.initials: J
authors.lastname: Pasic
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000706:statistics & numerical data