Length of stay for pediatric mental health ED visits has significantly increased

Rates of prolonged length of stay for pediatric mental health ED visits significantly increased between 2005 and 2015 compared with non-mental health-related ED visits, according to study results published in Pediatrics.

“If we think of ED length of stay as a proxy for quality and access it is important to understand not just how we are doing on a national level, but also our trajectory over time,” Katherine A. Nash, MD, of the National Clinician Scholars Program at Yale University School of Medicine, told Healio Psychiatry. “We found that this problem is getting worse, with more and more children each year spending hours and days in the ED, which represents a delay in the care that they need.”

Nash and colleagues aimed to compare trends in length of stay for pediatric mental health vs. non-mental health ED visits, as well as to assess patients’ characteristics linked to prolonged length of stay for mental health ED visits. They used the National Hospital Ambulatory Medical Care Survey (2005-2015) to conduct an observational analysis of ED visits for children aged 6 to 17 years. Specifically, they used descriptive statistics and survey-weighted logistic regression to evaluate trends in rates of prolonged length of stay and whether demographic and clinical characteristics, such as race and ethnicity, payer type and presence of a concurrent physical health diagnosis, affected prolonged length of stay.

Results showed that from 2005 to 2006 and 2014 to 2015, the average annual rate of ED length of stay longer than 6 hours for mental health visits increased from 16.3% to 24.6% and from 5.3% to 12.7% for length of stay longer than 12 hours; however, length of stay was stable for non-mental health visits. Hispanic ethnicity was linked to an almost three-times increased risk for length of stay longer than 12 hours (OR = 2.74; 95% CI, 1.6904.44) for mental health visits, but payer type did appear associated with difference in length of stay.

“For kids with mental health needs, every hour spent in the ED is likely a delay in necessary mental and behavioral health care,” Nash said. “An increasing number of children are experiencing these delays and this problem is only going to get worse in the aftermath of COVID-19, where we are seeing an increased number of children coming to the ED seeking mental health care.”