Because the hospitals in the study are not part of major academic systems, they likely do not always have child psychiatrists or other specialists in-house to work with emergency medicine teams in assessing and creating treatment plans for children in mental health crisis.
Janke and his colleagues from Yale University, the American College of Emergency Physicians and Columbia University used data from the Clinical Emergency Data Registry, with data from 107 community hospitals from January 2020 to December 2021, plus data from 2019 from 33 of those hospitals.
The majority of emergency department visits by children and teens in the United States happen in such hospitals, Janke notes. More resources that could help families get care in the local community or via telehealth could reduce the need to seek emergency care for their child, he says. Also needed are more resources to support local emergency medicine teams who find themselves caring for a child or teen in mental health crisis.
“While others are studying the epidemiology of mental health concerns among American’s youth at this point in the pandemic, our study focuses on whether the mental health system is ready for what’s coming in the door,” he said. “And the length of emergency department stays that we’re seeing here shows that it is not.”
The data source does not contain information about individual characteristics of the patients seeking care, such as what kinds of mental health care they’ve received, their demographic information, or what caused their families to seek emergency mental health care.
Janke and colleagues are working on further research on this topic. But the study does show that hospitals in the northeastern part of the country were most likely to have longer ED stays than other regions, especially the south and west.
The study does not measure “boarding” times, which is the time between an emergency care clinician’s decision to admit a patient to the time that patient actually leaves the ED for a bed in that hospital or another facility. But in a paper published earlier this year, Janke and colleagues showed that by the end of 2021, median boarding times for adult emergency patients were approaching the nationally recommended level of 3.4 hours.
In addition to Janke, the study’s authors are Katherine A. Nash, MD, Pawan Goyal, MD, Marc Auerbach, MD, MSc and Arjun K. Venkatesh, MD, MBA, MHS.
The study was funded by Janke’s support from the VA Office of Academic Affiliation as part of the National Clinician Scholars Program at the VA Ann Arbor/University of Michigan Institute for Healthcare Policy and Innovation.