Prolonged Behavioral Health Holds in the Pediatric Emergency Department: Patterns and Systemic Strain

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Objective: There has been a significant increase in the number of patients presenting to the Pediatric Emergency Departments for behavioral health complaints.This paper reviews the demographics, diagnoses, psychiatric histories and reported adverse childhood experiences of these patients, in addition to analyzing the hospital revenue lost resulting from the lack of reimbursement.Method: This is a retrospective study, done by extracting data from the hospital's data warehouse.We reviewed the charts for patients seen in the Pediatric Emergency Department of a medium sized tertiary, urban, academic hospital from January 2nd, 2020 -September 22nd, 2022 for behavioral health complaints.Results: A steady increase in behavioral health patient visits from 2020 to 2022 was noted and 14.5% of the total number of patients had at least two or more ED visits during the study period.The average age for patients presenting to the ED with behavioral health complaints was 13.86 years, 70.2% patients were biologically female and the most common race reported was white.97.3% of patients reported suicidal ideation and only 8.2% reported homicidal ideation.Review of our data showed that behavioral health patients stayed in the ED for an average of 2,038 minutes compared to 261 minutes for patients presenting with similar triage level for medical complaints.The hospital received an average of $8/hour reimbursement from insurance companies which was 6.8% of what was billed.Conclusion: This study highlights the increasing prevalence of behavioral health issues in our pediatric and adolescent populations and sheds light on critical gaps in both outpatient and inpatient mental health resources for children and adolescents.More resources are required at both local and national levels to help pediatric patients deal with stressors from adverse childhood experiences.

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