Snow Kathleen D, Mansbach Jonathan M, Cortina Christopher, Berry Jay G, Growdon Amanda S, Stoeck Patricia A, Walsh Kathleen
Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Pediatrics. 2025 Feb 13. doi: 10.1542/peds.2024-068283.
Boarding for pediatric mental health (MH) conditions is common at US children's hospitals while patients await care at a psychiatric facility. We sought to describe recent trends in boarding encounters and to identify factors associated with prolonged length of stay.
We performed a retrospective cross-sectional study analyzing pediatric MH boarding encounters at 40 tertiary children's hospitals included in the Pediatric Health Information System database between January 1, 2017, and December 31, 2023. Children ages 3 to 18 presenting with a primary psychiatric diagnosis were included in the analysis. We assessed trends in boarding encounters and length of stay over time and analyzed variations in boarding practices among hospitals. Risk factors for prolonged boarding (≥9 days) were identified using mixed effects logistic regression models.
Between 2017 and 2023, there were 100 784 boarding encounters across 40 hospitals. Median length of stay for boarding encounters increased from 3 to 4 days (P < .001) and 350 (0.3%) children had stays of longer than 100 days. Boarding practices varied significantly by hospital site. Factors associated with prolonged boarding included older age, government insurance type, increasing medical complexity, specific psychiatric disorder, season of presentation, and discharge disposition to home.
Boarding while awaiting acute psychiatric care remains common, with a sustained increase in the volume of boarding encounters and length of stay since the onset of the COVID-19 pandemic. Patients with medical and/or psychiatric complexity may be more likely to experience prolonged boarding, highlighting an area for improved access to care.
在美国儿童医院，当儿科患者等待精神科治疗时，住院等待精神健康（MH）疾病治疗的情况很常见。我们试图描述近期住院等待治疗情况的趋势，并确定与住院时间延长相关的因素。
我们进行了一项回顾性横断面研究，分析了2017年1月1日至2023年12月31日期间儿科健康信息系统数据库中40家三级儿童医院的儿科MH住院等待治疗情况。分析纳入了年龄在3至18岁、患有原发性精神疾病诊断的儿童。我们评估了住院等待治疗情况和住院时间随时间的趋势，并分析了各医院住院治疗方式的差异。使用混合效应逻辑回归模型确定住院时间延长（≥9天）的危险因素。
2017年至2023年期间，40家医院共有100784例住院等待治疗情况。住院等待治疗的中位时间从3天增加到4天（P < 0.001），350名（0.3%）儿童的住院时间超过100天。不同医院的住院治疗方式差异显著。与住院时间延长相关的因素包括年龄较大、政府保险类型、医疗复杂性增加、特定精神疾病、就诊季节以及出院回家的处置方式。
在等待急性精神科护理期间住院等待治疗的情况仍然很常见，自新冠疫情爆发以来，住院等待治疗的数量和住院时间持续增加。患有医疗和/或精神疾病复杂性的患者可能更有可能经历较长时间的住院等待，这突出了一个需要改善就医机会的领域。
