No room at the inn: pediatric psychiatric patients wait far longer for inpatient beds than their non-psychiatric counterparts; evidence of structural stigma.

Background: Pediatric emergency department (ED) boarding has considerable implications on patient care, safety, and outcomes. Few Canadian studies explore pediatric patients' boarding. Understanding which pediatric presentations are impacted by boarding is fundamental to informing psychiatric infrastructure, public policy, and system improvements. Our primary objective was to explore pediatric and adolescent ED median boarding time for psychiatric patients versus non-psychiatric patients while considering the impact of COVID-19 on boarding trends.

Methods: We performed an observational study for 96 EDs in Alberta, Canada using the National Ambulatory Care Reporting System data from 2018-2023. Admitted patients aged 6-17 were included and classified as psychiatric or non-psychiatric using the International Statistical Classification of Diseases. Boarding was defined as the time from admission decision to patients departing the ED. Descriptive statistics summarized patient and ED visit characteristics and median (IQR) boarding time during three time periods to account for COVID-19. Semi-parametric interrupted time-series analysis compared psychiatric and non-psychiatric patient boarding trends.

Results: A total of 38,821 pediatric and adolescent patients were admitted from an ED with psychiatric (25%) or non-psychiatric (75%) diagnoses. Psychiatric patients were predominantly female (70.6%) with an older median age of 15. The median (IQR) boarding time for psychiatric patients was 156% longer (241 min (88-1023)) than non-psychiatric patients (93 min (53-1590)). Comparing the initial and final study periods, psychiatric boarding increased by 52% (94 min), and non-psychiatric patient boarding increased by 7% (7 min).

Conclusion: This is the largest and most recent comparison of pediatric and adolescent psychiatric and non-psychiatric boarding in Canada. Pediatric psychiatric patients experience substantially longer ED boarding times than non-psychiatric patients and worsened to a greater extent over the 5-year period. Our findings suggest substantial inequity in pediatric psychiatric patients' access to inpatient acute care beds and disparities in hospital-based psychiatric care.