Stabilizing Pediatric Patients During Psychiatric Boarding: A Quality Improvement Project.

Abstract

BACKGROUND AND OBJECTIVES Psychiatric boarding has implications for youth, their families, and hospital systems. We undertook a quality improvement (QI) project to address boarding at our institution. We aimed to stabilize patients who were boarding in our emergency department (ED) observation unit and to decrease the percentage of patients admitted to psychiatric facilities. METHODS A multidisciplinary team created a stabilization protocol focused on enhancing coping strategies and family communication and providing psychoeducation and safety planning. This program was piloted in a group of patients experiencing boarding beginning in March 2021. Implementing the protocol involved additional staffing, plans for structured daily activities, and enhancements to the electronic health record. RESULTS During the baseline period (January 2019-February 2021), 65.7% (n = 498) of encounters in which patients boarded in the ED observation unit resulted in the patient being admitted to a psychiatric facility compared with 49.0% (n = 373) of encounters during the intervention period, reflecting a centerline shift on a statistical process control chart. From March 2021 to May 2022 (intervention period), 159 patients participated in the stabilization protocol across 164 encounters. Compared with similar nonpilot encounters (n = 446) occurring during the same period, pilot encounters (n = 164) were less likely to result in admission to a psychiatric facility (22.6% vs 58.2%) and were more likely to result in the patient being discharged home (75.0% vs 31.4%). CONCLUSION This QI project resulted in fewer patients being transferred to inpatient psychiatric care. This program illustrates that medical hospitals can creatively improve care for patients experiencing boarding.