Hudgins Joel D, Monuteaux Michael C, Kent Caitlin, Mannix Rebekah, Miller Andrew, Marchese Ashley, Levy Jason
Department of Emergency Medicine, Harvard Medical School, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Department of Emergency Medicine, Harvard Medical School, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
Ann Emerg Med. 2025 May;85(5):381-392. doi: 10.1016/j.annemergmed.2024.10.017. Epub 2024 Nov 27.
Over the past decade, there has been a dramatic increase in pediatric emergency department (PED) visits seeking mental and behavioral health care. We aimed to determine the relationship between hours of care devoted to patients with mental and behavioral health complaints and markers of PED throughput and timeliness.
We performed a retrospective, single-center, cross-sectional study of PED encounters between 2010 and 2022. We reported effect of care for patients with mental and behavioral health complaints on operational metrics, including 4 throughput metrics and 3 care metrics (eg, vital signs within 30 minutes of arrival or left without being seen rates). We estimated a series of negative binomial regression models with the monthly count of the given metric as the dependent variable and monthly ED volume as the offset.
We included a total of 720,914 visits over the study period, of which 22,901 (3.2%) were mental and behavioral health complaints. The total number of mental and behavioral health visits increased over the study period, from 1,113 in 2010 to 2,554 in 2021, whereas the median monthly behavioral health care hours showed a 1,483% increase. All outcomes worsened as behavioral health care hours increased in both operational and care categories.
In our single-center study, the increase in mental and behavioral health visits and hours of care was associated with significantly worsened PED throughput and timeliness of care metrics. This relationship highlights the challenges that PEDs face in caring for mental and behavioral health patients while simultaneously providing high-quality care to patients with acute nonmental and behavioral health emergencies.
在过去十年中，寻求精神和行为健康护理的儿科急诊科（PED）就诊人数急剧增加。我们旨在确定用于处理精神和行为健康问题患者的护理时长与PED工作效率及及时性指标之间的关系。
我们对2010年至2022年间的PED就诊情况进行了一项回顾性、单中心横断面研究。我们报告了针对精神和行为健康问题患者的护理对运营指标的影响，包括4个工作效率指标和3个护理指标（如到达后30分钟内测量生命体征或未就诊离开率）。我们估计了一系列负二项回归模型，将给定指标的月度计数作为因变量，将每月急诊量作为偏移量。
在研究期间，我们共纳入了720,914次就诊，其中22,901次（3.2%）是精神和行为健康问题。在研究期间，精神和行为健康就诊的总数有所增加，从2010年的1,113次增加到2021年的2,554次，而每月行为健康护理时长的中位数增长了1483%。在运营和护理类别中，随着行为健康护理时长的增加，所有结果都变差了。
在我们的单中心研究中，精神和行为健康就诊次数及护理时长的增加与PED工作效率和护理指标及时性的显著恶化相关。这种关系凸显了PED在护理精神和行为健康患者的同时，为急性非精神和行为健康紧急情况患者提供高质量护理时所面临的挑战。
