Impact of a Pediatric Mental Health Crisis Service in the emergency department on hospital resource utilization: an interrupted time series analysis.

Abstract

BACKGROUND Lengthening waitlists, reduced outpatient care availability, and increased numbers of children experiencing mental health (MH) crises have strained emergency departments (EDs). EDs facilitate access to immediate intervention and triage to acute services but are often underresourced and undertrained to manage the unique needs of mental health crises. The combination of demand, complexity, and resources required encouraged the development of specialized mental health crisis services. In 2021, CAMHS Crisis Connect (CCC) was established at Perth Children's Hospital and aims to improve patient flow, reduce hospital resource utilization, and improve the experience of children experiencing crises. METHODS The aim of the current study is to examine a pediatric crisis intervention service in a West Australian context. We implement interrupted time series analyses (ITS), a quasi-experimental statistical methodology allowing us to make causal interpretations of CCC impact on hospital resource utilization. RESULTS The key effect here is the substantial reduction in presentations and re-presentations to ED and inpatient wards that are sustained across the long term and directly attributable to CCC. However, there is an increasing length of stay in ED and the very small and potentially not clinically meaningful reduction in inpatient bed occupancy, which requires further investigation. CONCLUSIONS Our results support specialized, multi-faceted crisis care programs in ED to ensure accessibility of acute, intensive care for those with severe and complex needs, supporting the journey for children who may be more effectively managed in community and outpatient settings.