title: Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments.
abstract: OBJECTIVE
  Prolonged boarding times in the emergency department (ED) disproportionately affect mental health patients, resulting in patient and provider dissatisfaction and increased patient morbidity and mortality. Our objective is to quantify the burden of mental health boarding and to elucidate the effect of insurance together with demographic, social, and comorbid factors on length of stay.
  
  
  METHODS
  We conducted a cross-sectional observational study of 871 consecutive patients requiring an ED mental health evaluation at one of 10 unaffiliated Massachusetts hospitals. Demographics; insurance; length of stay; medical, psychiatric, and social history; and disposition data were collected. We evaluated the effect of these characteristics on boarding time.
  
  
  RESULTS
  ED median length of stay varied greatly by disposition, driven primarily by ED boarding time. Admitted and transferred patients had longer delays than discharged patients (5.63, 9.32, and 1.23 hours, respectively). Medical clearance time (1.40 hours) composed only 10.5% of total ED length of stay and varied little by insurance. In our multivariate analyses, patients with Medicaid and the uninsured had significantly longer total lengths of stay and were more than twice as likely to remain in the ED for 24 hours or greater compared with privately insured patients.
  
  
  CONCLUSIONS
  Mental health patients in Massachusetts have lengthy ED visits, particularly those requiring inpatient admission. Boarding time accounts for the majority of total ED length of stay and varies by insurance, even when other factors known to affect ED length of stay are controlled. Efforts to improve timeliness of care for mental health emergencies should focus on reducing ED boarding and eliminating disparities in care by insurance status.
authors.affiliation: Department of Emergency Medicine, Steward St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA. Electronic address: mark.pearlmutter.md@steward.org.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Pearlmutter
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, Brown Medical School, Providence, RI.
authors.forename: Kristin H
authors.initials: KH
authors.lastname: Dwyer
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Burke
authors.affiliation: Department of Emergency Medicine, Baystate Medical Center, Tufts University School of Medicine.
authors.forename: Niels
authors.initials: N
authors.lastname: Rathlev
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School.
authors.forename: Louise
authors.initials: L
authors.lastname: Maranda
authors.affiliation: Department of Emergency Medicine, University Mass Memorial Medical Center.
authors.forename: Greg
authors.initials: G
authors.lastname: Volturo
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer; D014481:United States; D055815:Young Adult