Afzal Saira, Gunnison Claire, Rudofker Adam, Esposito Jeremy, Geddings Weston
Department of Social Work, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Bryn Mawr College Graduate School of Social Work and Social Research, Bryn Mawr, Pennsylvania.
Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2023-063262.
Psychiatric boarding has implications for youth, their families, and hospital systems. We undertook a quality improvement (QI) project to address boarding at our institution. We aimed to stabilize patients who were boarding in our emergency department (ED) observation unit and to decrease the percentage of patients admitted to psychiatric facilities.
A multidisciplinary team created a stabilization protocol focused on enhancing coping strategies and family communication and providing psychoeducation and safety planning. This program was piloted in a group of patients experiencing boarding beginning in March 2021. Implementing the protocol involved additional staffing, plans for structured daily activities, and enhancements to the electronic health record.
During the baseline period (January 2019-February 2021), 65.7% (n = 498) of encounters in which patients boarded in the ED observation unit resulted in the patient being admitted to a psychiatric facility compared with 49.0% (n = 373) of encounters during the intervention period, reflecting a centerline shift on a statistical process control chart. From March 2021 to May 2022 (intervention period), 159 patients participated in the stabilization protocol across 164 encounters. Compared with similar nonpilot encounters (n = 446) occurring during the same period, pilot encounters (n = 164) were less likely to result in admission to a psychiatric facility (22.6% vs 58.2%) and were more likely to result in the patient being discharged home (75.0% vs 31.4%).
This QI project resulted in fewer patients being transferred to inpatient psychiatric care. This program illustrates that medical hospitals can creatively improve care for patients experiencing boarding.
精神科住院对青少年及其家庭以及医院系统都有影响。我们开展了一项质量改进（QI）项目，以解决我院的住院问题。我们的目标是稳定在急诊科（ED）观察病房住院的患者，并降低入住精神科设施的患者比例。
一个多学科团队制定了一项稳定方案，重点是增强应对策略和家庭沟通，并提供心理教育和安全规划。该方案于2021年3月开始在一组经历住院的患者中进行试点。实施该方案需要额外的人员配备、结构化日常活动计划以及电子健康记录的改进。
在基线期（2019年1月至2021年2月），在ED观察病房住院的患者中，65.7%（n = 498）的会诊导致患者入住精神科设施，而在干预期为49.0%（n = 373），这反映了统计过程控制图上的中心线偏移。从2021年3月到2022年5月（干预期），159名患者在164次会诊中参与了稳定方案。与同期发生的类似非试点会诊（n = 446）相比，试点会诊（n = 164）导致入住精神科设施的可能性更小（22.6%对58.2%），且患者更有可能出院回家（75.0%对31.4%）。
这项QI项目减少了转入住院精神科护理的患者数量。该方案表明，综合医院可以创造性地改善对住院患者的护理。
