Wharff Elizabeth A, Ginnis Katherine B, Ross Abigail M, Blood Emily A
Emergency Psychiatry Services, Children's Hospital Boston, Boston, MA 02115, USA.
Pediatr Emerg Care. 2011 Jun;27(6):483-9. doi: 10.1097/PEC.0b013e31821d8571.
Patients who present to the emergency department (ED) and require psychiatric hospitalization may wait in the ED or be admitted to a medical service because there are no available inpatient psychiatric beds. These patients are psychiatric "boarders." This study describes the extent of the boarder problem in a large, urban pediatric ED, compares characteristics of psychiatrically hospitalized patients with boarders, and compares predictors of boarding in 2 ED patient cohorts.
A retrospective cohort study was conducted in 2007-2008. The main outcome measure was placement into a psychiatric facility or boarding. Predictors of boarding in the present analysis were compared with predictors from a similar study conducted in the same ED in 1999-2000.
Of 461 ED patient encounters requiring psychiatric admission, 157 (34.1%) boarded. Mean and median boarding duration for the sample were 22.7(SD, 8.08) and 21.18 hours, respectively. Univariate generalized estimating equations demonstrated increased boarding odds for patients carrying Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses of autism, mental retardation, and/or developmental delay (P = 0.01), presenting during the weekend (P = 0.03) or presenting during months without school vacation (P = 0.02). Suicidal ideation (SI) significantly predicted boarding status, with increased likelihood of boarding for severe SI (P = 0.02). Age, race, insurance status, and homicidal ideation did not significantly predict boarding in the 2007-2008 patient cohort, although they did in the earlier study. Systemic factors and SI predicted boarding status in both cohorts.
Suicidal patients continue to board. Limits within the system, including timing of ED presentation and a dearth of specialized services, still exist, elevating the risk of boarding for some populations. Implications for pediatric ED psychiatric care delivery are discussed.
前往急诊科（ED）就诊且需要精神科住院治疗的患者，可能会因没有可用的精神科住院床位而在急诊科等待或被收治到内科。这些患者就是精神科“寄宿者”。本研究描述了一家大型城市儿科急诊科中寄宿者问题的严重程度，比较了精神科住院患者与寄宿者的特征，并比较了两个急诊科患者队列中寄宿情况的预测因素。
在2007 - 2008年进行了一项回顾性队列研究。主要结局指标是被安置到精神科机构或成为寄宿者。将本次分析中寄宿情况的预测因素与1999 - 2000年在同一急诊科进行的类似研究中的预测因素进行比较。
在461例需要精神科住院治疗的急诊科患者中，157例（34.1%）成为了寄宿者。样本的平均寄宿时长和中位数寄宿时长分别为22.7（标准差，8.08）小时和21.18小时。单变量广义估计方程显示，患有《精神疾病诊断与统计手册》第四版中自闭症、智力障碍和/或发育迟缓诊断的患者成为寄宿者的几率增加（P = 0.01），在周末就诊的患者（P = 0.03）或在没有学校假期的月份就诊的患者（P = 0.02）成为寄宿者的几率增加。自杀意念（SI）显著预测了寄宿状态，严重自杀意念的患者成为寄宿者的可能性增加（P = 0.02）。年龄、种族、保险状况和杀人意念在2007 - 2008年的患者队列中并未显著预测寄宿情况，尽管在早期研究中它们具有预测作用。系统因素和自杀意念在两个队列中均预测了寄宿状态。
有自杀倾向的患者仍会成为寄宿者。系统内的限制因素，包括急诊科就诊时间和专业服务的匮乏仍然存在，这增加了某些人群成为寄宿者的风险。文中讨论了对儿科急诊科精神科护理的影响。
