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Psychiatric Boarding Incidence, Duration, and Associated Factors in United States Emergency Departments

  • Jason M. Nolan
    Correspondence
    For correspondence, write: Jason M. Nolan, PhD, 2645 Barton Hills Drive, Austin, TX 78704.
    Affiliations
    San Francisco, CA
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  • Author Footnotes
    1 Dr. Christopher Fee has received consultancy fees from Google and honoraria from the University of California, San Francisco Office of Continuing Medical Education for organizing and speaking at an annual CME course. Information in this article was presented as a poster at the American College of Emergency Physicians Research Forum in Denver, CO, on October 8, 2012.
    Christopher Fee
    Footnotes
    1 Dr. Christopher Fee has received consultancy fees from Google and honoraria from the University of California, San Francisco Office of Continuing Medical Education for organizing and speaking at an annual CME course. Information in this article was presented as a poster at the American College of Emergency Physicians Research Forum in Denver, CO, on October 8, 2012.
    Affiliations
    San Francisco, CA
    Search for articles by this author
  • Bruce A. Cooper
    Affiliations
    San Francisco, CA
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  • Sally H. Rankin
    Affiliations
    San Francisco, CA
    Search for articles by this author
  • Mary A. Blegen
    Affiliations
    San Francisco, CA
    Search for articles by this author
  • Author Footnotes
    1 Dr. Christopher Fee has received consultancy fees from Google and honoraria from the University of California, San Francisco Office of Continuing Medical Education for organizing and speaking at an annual CME course. Information in this article was presented as a poster at the American College of Emergency Physicians Research Forum in Denver, CO, on October 8, 2012.

      Introduction

      Boarding, especially among psychiatric patients, has been characterized as a significant cause of ED crowding, but no quantitative analysis has described boarding nationally. This study determines the incidence, duration, and factors associated with ED boarding in the United States.

      Methods

      2008 National Hospital Ambulatory Medical Care Survey ED data were stratified by visit type (psychiatric vs. non-psychiatric), boarding status, and patient and hospital characteristics. Boarding was defined as a visit with an ED length of stay >6 hours, and boarding time as ED length of stay minus 6 hours. Pearson’s chi-square tests describe hospital and patient characteristics stratified by boarding status. Multilevel multivariable logistic and linear regressions determine associations with boarding and boarding time.

      Results

      While 11% of all ED patients boarded, 21.5% of all psychiatric ED patients boarded. Boarding was also more prolonged for psychiatric ED patients. Controlling for confounders, odds of boarding for psychiatric patients were 4.78 (2.63-8.66) times higher than non-psychiatric, and psychiatric patients boarded 2.78 (1.91-3.64) hours longer than non-psychiatric.

      Discussion

      US EDs experienced high proportions and durations of boarding with psychiatric patients disproportionately affected. Additional research concerning mental health care services and legislation may be required to address ED psychiatric patient boarding.

      Key words

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      Biography

      Jason M. Nolan, Member, ENA Chapter 329, is Clinical Nurse, Emergency Department, University of California, San Francisco, San Francisco, CA.

      Biography

      Christopher Fee is Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.

      Biography

      Bruce A. Cooper is Senior Statistician, Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA.

      Biography

      Sally H. Rankin is Professor, Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA.

      Biography

      Mary A. Blegen is Professor, Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, CA.