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Cited by 43Emergency and Acute Care StudiesPsychiatric care and mental health servicesHealthcare Operations and Scheduling Optimization

Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping

Open access
Wolff, Jennifer C., Maron, Micaela, Chou, Tommy, Hood, Erik, Sodano, Sophia, Cheek, Shayna, Thompson, Elizabeth, Donise, Kathleen +2 more·2023·Administration and Policy in Mental Health and Mental Health Services Research
DOI 10.1007/s10488-022-01249-4PMC PMC9822692
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Abstract

Over the past decade, healthcare providers nationwide have contended with a growing boarding crisis as pediatric patients await psychiatric treatment in emergency departments (EDs). COVID-19 has exacerbated this urgent youth mental health crisis, driving EDs to act as crisis units. Journey mapping is a robust methodology with which to examine strengths and challenges in patient care workflows such as boarding and emergency psychiatric care. Psychiatric, emergency medicine, and hospitalist providers serving patients boarding at a northeastern children’s hospital participated in semi-structured qualitative interviews. Investigators conducted directed content analysis with an inductive approach to identify facilitators, barriers, and persistent needs of boarding patients, which were summarized in a patient journey map. Findings were presented to participants for feedback and further refinement. Quantitative data showed a three-fold increase in the number of patients who boarded over the past three years and a 60% increase in the average time spent boarding in the ED. Emergent qualitative data indicated three stages in the boarding process: Initial Evaluation, Admitted to Board, and Discharge. Data highlighted positive and negative factors affecting patient safety, availability of beds in pediatric hospital and psychiatric inpatient settings, high patient-provider ratios that limited staffing support, and roadblocks in care coordination and disposition planning. Patient journey mapping provided insight into providers’ experiences serving patients boarding for psychiatric reasons. Findings described bright points and pain points at each stage of the boarding process with implications for psychiatric care and systemic changes to reduce boarding volume and length of stay.

AI snapshot

Written from the paper’s full text.

TL;DR

This mixed-methods study used staff interviews and patient journey mapping to examine pediatric psychiatric boarding at a northeastern children’s hospital, identifying three phases: Initial Evaluation, Admitted to Board, and Discharge. Chart review showed boarding volume and ED boarding time rose sharply from 2019 to 2021, while qualitative findings highlighted teamwork and safety as bright points and space, staffing, care coordination, and placement barriers as pain points.

Key findings

  • Boarding volume increased from 260 patients in 2019 to 837 in 2021, and 49% of 2021 psychiatric presentations required a higher level of care.
  • Average ED boarding time rose 61% from 2019 to 2021 (11.76 to 18.96 hours), while average total boarding remained about 3–4 days; medical-floor boarding decreased by about 14 hours and total boarding by about six hours in 2021 compared with 2019.
  • Staff described three journey stages—Initial Evaluation, Admitted to Board, and Discharge—with bright points including standardized suicide risk assessment (Columbia-Suicide Severity Rating Scale), team communication, leadership support, and safety maintenance.
  • Pain points included extended ED waits, limited physical space and privacy, high patient volume and staffing shortages, difficulty meeting basic needs, limited therapeutic intervention, unclear responsibility between hospitalist and consult-liaison teams, inefficient discharge coordination, lack of outpatient/lower-level care options, and placement restrictions affecting gender minority youth.

Methods

  • Emergent mixed-methods design at a standalone children’s hospital in the northeastern United States, where over 4,000 youth presented annually for psychiatric concerns, about 8% of the total patient population.
  • Semi-structured qualitative interviews with 15 healthcare providers from psychiatric consult-liaison, pediatric psychiatric emergency services, nursing, social work, and pediatric/adolescent medicine hospitalist teams; interviews lasted approximately 20–45 minutes and were conducted September–December 2021.
  • Directed/inductive content analysis and journey mapping following Galloway’s guidelines, with iterative coding, team consensus, stakeholder validation, and chart review data from fiscal years 2019–2021.

Limitations

  • Stated: the study interviewed medical providers only and did not gather youth or family perspectives; it was conducted at a single academic standalone children’s hospital, so results may not apply to general or community hospitals; and the journey map did not extend to pre-ED factors or outside systems contributing to bottlenecks.
  • Evident from the text: findings are based on staff accounts and local chart review without patient-level outcomes or comparison across sites, limiting generalizability and direct assessment of patient experience.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s10488-022-01249-4

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 27 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Multiple interviewees noted a lack of appropriate physical space to place patients while they awaited clinician decisions and placements.

    “Multiple interviewees noted the lack of appropriate physical space to place patients while they awaited clinician decisions and placements.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The ED and supporting CL and Pedi PES teams were not designed to support the volume and acuity of patients presenting with mental health concerns.

    “Contributing to long wait times, the ED and supporting CL and Pedi PES teams were not designed to support the volume and acuity of patients presenting with mental health concerns.”
    Quote in the paperSubstantial claim
  • Findingown data

    Emergent data from the qualitative interviews suggested that there were three phases that reflected the timeline of the patient journey: Initial Evaluation, Admission to Board, and Discharge.

    “Emergent data from the qualitative interviews suggested that there were three phases that reflected the timeline of the patient journey: Initial Evaluation, Admission to Board, and Discharge (See Figure. 1).”
    Quote in the paperSubstantial claim
  • Findingown data

    The overarching pain point at the initial evaluation stage was extended wait times.

    “In terms of pain points, the overarching theme at this stage was extended wait times.”
    Quote in the paperNot a substantial claim
  • Findingown data

    From 2019 to 2021, there was a 61% increase in the average length of time patients spent in the ED.

    “From 2019 to 2021, there was a 61% increase in the average length of time patients spent in the ED.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 31
  • May combine two claims. 40

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Security staff availability, crucial for ensuring a safe environment with patients of varying acuity, was cited as 'a big problem right now; we've lost a lot of staff in the past few months.'

    “Security staff availability, which was crucial for ensuring a safe environment with patients of varying acuity, was cited as “a big problem right now; we’ve lost a lot of staff in the past few months.””
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    On average, over 4,000 youth presented at the target hospital each year for psychiatric concerns, accounting for approximately 8% of the total patient population.

    “On average, over 4,000 youth presented at the target hospital each year for psychiatric concerns, accounting for approximately 8% of the total patient population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Patients spent about 14 hours less on average on a medical floor and six hours less in total time boarding in 2021 compared to 2019.

    “Although there was an increase in presentations to the ED and time spent waiting in the ED, patients spent about 14 hours less on average on a medical floor and six hours less in total time boarding in 2021 compared to 2019.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    There were simply not enough clinicians to meet the emergency psychiatric needs of patients, given no cap for volume of patients in these settings compared to the finite number of beds on an inpatient psychiatric unit.

    “Administrative staff expressed that “with no cap for the volume of patients in these settings, compared to the finite number of beds on an inpatient psychiatric unit, there were simply not enough clinicians [to meet the emergency psychiatric needs of patients].””
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Observing varying psychiatric needs (e.g., aggression, psychosis) may have created emotional distress for patients and families waiting in proximity.

    “Observing varying psychiatric needs (e.g., aggression, psychosis), may also have created emotional distress for patients and families waiting in proximity.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    During ED triage, patients completed the Columbia-Suicide Severity Rating Scale, a standardized assessment that was used to guide clinical decisions around safety.

    “During ED triage, patients completed the Columbia-Suicide Severity Rating Scale, a standardized assessment that was used to guide clinical decisions around safety.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many interviewees expressed that as a team they work well together to make sure every child is seen and they do the best they can.

    “Many interviewees expressed “as a team we work well together to make sure every child is seen; we do the best we can.””
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The CSSRS information was helpful in identifying the patient's primary concern and providing the assessing clinician with a baseline for Pedi PES involvement.

    “This information was helpful in identifying the patient’s primary concern and providing the assessing clinician with a baseline for Pedi PES involvement.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The ED waiting space is only 'a little waiting room' that cannot meet the needs of patient and family volume.

    “One Pedi PES provider described the ED waiting space as only “a little waiting room” that cannot meet the needs of patient and family volume.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The noise of the ED and lack of privacy for conversations was a common family frustration.

    “Further, one PES provider described, the noise of the ED and lack of privacy for conversations was a common family frustration.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Others spoke to the strong support they feel from team leadership.

    “Others spoke to the strong support they feel from team leadership.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The PBI team provided necessary therapeutic support for patients and staff, but was not large enough to support the immense influx of patients in need of psychiatric care.

    “While the PBI team provided necessary therapeutic support for patients and staff, the team was unfortunately not large enough to support the immense influx of patients in need of psychiatric care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The study identified the main phases of the patient journey through the local ED (Initial Evaluation, Admission to Board, Discharge) and explored positive and negative components of each phase based on providers' reports.

    “The study identified the main phases of the patient journey through the local ED (Initial Evaluation, Admission to Board, Discharge) and further explored the positive and negative components of each phase based on providers’ reports.”
    • Also stated in: § Conclusion · plain
      “The study identified three phases of this journey through the boarding process and provided insight into the positive and negative components of each phase.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    There was a potential for diffusion of responsibility due to overlap of hospitalists and psych CL service.

    “there was a potential for “diffusion of responsibility in which people slowly become a little less detail-oriented due to the overlap of hospitalists and psych CL service””
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The number one barrier to changing a disposition plan once a patient is boarding is parents feeling terrified about safety.

    ““The number one barrier (to changing a disposition plan once a patient is boarding) is parents feeling terrified about safety.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pain points included the level of observation needed (e.g., 1:1, security) and patients' cohortability, or the degree to which different patient characteristics (e.g., age, psychiatric presentations, trauma, aggression, sexualized behavior) affects their ability to safely cohabitate in double rooms while awaiting psychiatric treatment.

    “These pain points included the level of observation needed (e.g., 1:1, security) and patients’ cohortability, or the degree to which different patient characteristics (e.g., age, psychiatric presentations, trauma, aggression, sexualized behavior) affects their ability to safely cohabitate in double rooms while awaiting psychiatric treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Time spent boarding in the ED increased 60% in 2021 compared to two years prior, while time spent boarding on a medical floor decreased somewhat during that same time period.

    “Time spent boarding in the ED increased 60% in 2021, compared to two years prior, while time spent boarding on a medical floor decreased somewhat during that same time period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The system was not specifically designed to address the need for the number of patients it was supporting, but it was moving patients towards appropriate care placements while maintaining safety.

    “Although the system was not specifically designed to address this need for the number of patients it was supporting, the system was moving patients towards appropriate care placements while maintaining safety.”
    • Also stated in: § Discussion · boosted
      “Results demonstrated that although the system was not specifically designed to support the acute needs of pediatric patients experiencing psychiatric crises, providers and staff were reaching the critical goal of maintaining safety for these high-risk youth while they awaited specialized psychiatric placement.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Medical rooms were not designed for psychiatric safety, with multiple ligature and other risks that may have threatened patient and staff safety.

    “Medical rooms were also not designed for psychiatric safety; there were multiple ligature and other risks that may have posed a threat for both patient and staff safety.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Providers within the services were strongly committed to these patients and worked together to engage patients in brief clinician interventions focused on safety in the hospital while they awaited more specialized care.

    “Although services were not designed to meet this high level of need, providers within the services were strongly committed to these patients and worked together to engage patients in brief clinician interventions focused on safety in the hospital while they awaited more specialized care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many interviewees noted increased length of stay on psychiatric inpatient units, a lack of outpatient providers, long waiting lists with in-home providers, and unavailable spots at lower levels of care.

    “Many interviewees noted increased length of stay on psychiatric inpatient units, a lack of outpatient providers, long waiting lists with in-home providers, and unavailable spots at lower levels of care (e.g., partial hospitalization programs).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The process to link patients with psychiatric services was labor intensive and time consuming, and sometimes patients left the hospital without being linked to appropriate care.

    “To link patients with psychiatric services, the process was labor intensive and time consuming, and sometimes patients left the hospital without being linked to appropriate care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The PBI service was described as a first line to help engage and de-escalate kids who are dysregulated before security is involved.

    “Others described this service as a first line to help engage and de-escalate kids who are dysregulated before security is involved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A tier system was developed in response to the growing number of boarded patients and the need to communicate level of patient risk more effectively as they boarded in a non-psychiatric physical space.

    “In one example, a tier system was developed in response to the growing number of boarded patients and the need to communicate level of patient risk more effectively as they boarded in a non-psychiatric physical space.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Many hospital staff were not trained in de-escalation and behavioral management skills, often leading to discomfort from minimal experience caring for psychiatric patients.

    “Many hospital staff were not trained in de-escalation and behavioral management skills, which often led to discomfort from minimal experience in caring for psychiatric patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No dedicated staff were available for coordinating the discharge process, so consult providers filled this role in addition to clinical services.

    “Because no dedicated staff were available for coordinating this process, consult providers filled this role in addition to the clinical services they provided.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The PBI team was described as a group of people who are not counselors/social workers/psychologists but are trained in some way in the system to provide therapeutic support with the kids all day to provide coping skills, distractions, etc.

    “This team was described as a “group of people who are not counselors/social workers/psychologists but are trained in some way in our system to provide therapeutic support with the kids all day to provide coping skills, distractions, etc.””
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The development of a patient journey map provided a snapshot of how care was delivered for acute pediatric psychiatric patients in an ED and primary medical setting, and helped illustrate contributing factors to excessive wait times.

    “The development of a patient journey map provided a snapshot of how care was delivered for acute pediatric psychiatric patients in an ED and primary medical setting.”
    • Also stated in: § Discussion · hedged
      “The current journey mapping approach provided a snapshot of the delivery of care and helped illustrate contributing factors to these excessive wait times that may be targets for future quality improvement initiatives in emergency settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The hospitalist and CL teams had multiple providers and trainees rotating daily, which increased numbers of supporting staff and challenges with continuity of care.

    “The hospitalist and CL teams also had multiple providers and trainees rotating in and out of services daily which increased both numbers of supporting staff and challenges with continuity of care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Many inpatient, residential, and group home placements have restrictions based on sex and gender, creating an extra barrier for gender minority youth.

    “Many inpatient, residential, and group home placements have restrictions based on sex and gender. This created an extra barrier for gender minority youth.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Our data was consistent with other studies that identified an excessive wait time of 20-40 hours on average for patients who are boarding, which grossly exceeds the Joint Commission's standard recommendation for disposition within four hours.

    “Overall, our data was consistent with other studies that have identified an excessive wait time of 20–40 hours on average for patients who are boarding, which grossly exceeds the Joint Commission’s standard recommendation for disposition within four hours (Leyenaar et al., 2021; Zeller et al., 2014).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Leyenaar et al., 2021 source

      Not checked in the free run.

    • cites Zeller et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Bright spots included supportive team functioning, collaboration, and communication.

    “Bright spots included supportive team functioning, collaboration, and communication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Other challenges related to discharge planning included individual patient and family factors such as patients refusing to safety plan or caregivers not feeling comfortable taking a child home.

    “Other challenges related to discharge planning and care coordination included individual patient and family factors such as patients refusing to safety plan or caregivers not feeling comfortable taking a child home.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Concerns with hospitalists acting as the primary team included feeling less equipped to manage psychiatric medications, prioritizing traditional medical cases when caseloads were high, and lacking a daily hand-off system.

    “Other concerns with hospitalists acting as the primary team included hospitalists feeling less equipped to manage psychiatric medications, prioritizing traditional medical cases when caseloads were high, and lacking a daily hand-off system to quickly understand the most pertinent updates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The standardized assessment of suicide in the ED was seen as a bright spot; however, there was no standardized assessment for aggression or homicidality in place.

    “The standardized assessment of suicide in the ED was seen as a bright spot; however, there was no standardized assessment for aggression or homicidality in place.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Not all providers could bill for care coordination efforts, limiting who could perform this task and how much time a given provider could dedicate to it.

    “It was also noted that not all providers could bill for care coordination efforts, further limiting who could perform this task and how much time a given provider was able to dedicate to it.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study demonstrated an increase of 329% in ED visits from 2007 to 2016 for deliberate self-harm.

    “a recent study demonstrated an increase of 329% in ED visits from 2007 to 2016 for deliberate self-harm”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lo et al., 2020

      Not checked in the free run.

    • cites Santillanes et al., 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The procedure of coding, research team discussion and consensus, stakeholder review, and revision occurred twice and concluded when sufficient agreement was met.

    “This procedure of coding, research team discussion and consensus, stakeholder review, and revision occurred twice and concluded when sufficient agreement was met.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Multiple members of the research team open coded interviews, developed and revised versions of the journey map based on interviews, and arrived at an internal consensus via group discussion.

    “Multiple members of the research team open coded interviews, developed and revised versions of the journey map based on interviews, and arrived at an internal consensus via group discussion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For youth ages 12-17, there was a 31% increase in mental health-related ED visits in 2020 compared to 2019.

    “For youth ages 12–17 specifically, there was a 31% increase in mental health-related ED visits in 2020 compared to 2019 (Yard et al., 2021)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Yard et al., 2021 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Following inductive content analysis, data presented in journey maps highlight common themes and systematic barriers to include in an initial map, which is then used to obtain additional cross validation and feedback for revision.

    “Following inductive content analysis, data presented in journey maps highlight common themes and systematic barriers to include in an initial map, which is then used to obtain additional cross validation and feedback for revision (Bearnot & Mitton, 2020; Vears & Gillam, 2022).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Bearnot & Mitton, 2020 source

      Not checked in the free run.

    • cites Vears & Gillam, 2022 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Between 2009 and 2015, mental health-related ED visits increased 56.4% for pediatric patients.

    “National trends in mental health show that between 2009 and 2015, mental health-related ED visits increased 56.4% for pediatric patients”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lo et al., 2020

      Not checked in the free run.

    • cites Santillanes et al., 2020 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Journey mapping provides a structured qualitative process by which to evaluate care of boarded patients.

    “Journey mapping – a research methodology often used in implementation science to assess organizational workflows in clinical settings – provides a structured qualitative process by which to evaluate care of boarded patients.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kushniruk et al., 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Interviews were conducted with two study staff present: one functioned as a primary interviewer and one functioned as a note-taker.

    “Interviews were conducted with two study staff present: one functioned as a primary interviewer (TC, EH, JW) and one functioned as a note-taker (SS, SC, MM).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The COVID-19 pandemic has further exacerbated the youth mental health crisis, intensifying urgency as hospitals respond to higher volumes of psychiatric emergencies.

    “The COVID-19 pandemic has further exacerbated the youth mental health crisis, intensifying urgency as hospitals respond to higher volumes of psychiatric emergencies.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kudinova et al., 2021 source

      Not checked in the free run.

    • cites Power et al., 2020 source

      Not checked in the free run.

    • cites Thompson et al., 2021 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many hospitals now report an average wait for admission or transfer to a psychiatric bed of 48 h.

    “many hospitals now report an average wait for admission or transfer to a psychiatric bed of 48 h (Leyenaar et al., 2021).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Leyenaar et al., 2021 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Direct quotes were obtained from the participants whenever possible.

    “Direct quotes were obtained from the participants whenever possible.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The local Institutional Review Board gave a determination of exemption for this study.

    “The local Institutional Review Board gave a determination of exemption for this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    A journey map is a visual representation of patients' movements through a complex healthcare system in a simple and succinct progression.

    “A journey map is a visual representation of patients’ movements through a complex healthcare system in a simple and succinct progression (Kushniruk et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kushniruk et al., 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Stakeholders contributed to the subsequent preparation and review of this manuscript to ensure accuracy of results and provide perspective to conclusions and discussion.

    “Stakeholders contributed to the subsequent preparation and review of this manuscript to ensure accuracy of results and provide perspective to conclusions and discussion.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Availability of community-based services and psychiatric inpatient beds has decreased, leaving fewer options for disposition and transfer to necessary care.

    “At the same time, availability of community-based services and psychiatric inpatient beds has decreased, leaving fewer options for disposition and transfer to necessary care (Nicks & Manthey, 2012).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Nicks & Manthey, 2012 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Premisecitation

    Stakeholders can utilize mapping insights to improve quality of care and facilitate a cohesive flow between the multiple healthcare disciplines involved in pediatric psychiatric patient care.

    “Further, stakeholders can utilize mapping insights to improve quality of care and facilitate a cohesive flow between the multiple healthcare disciplines involved in pediatric psychiatric patient care (Crowe et al., 2020; Trebble et al., 2010).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Crowe et al., 2020 source

      Not checked in the free run.

    • cites Trebble et al., 2010 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisereasoning

    The increased need for specialized psychiatric services and an inability to provide appropriate psychiatric intervention has led to a nationwide crisis as patients who are boarding wait days to weeks for a psychiatric placement.

    “The increased need for specialized psychiatric services and an inability to provide appropriate psychiatric intervention has led to a nationwide crisis as patients who are boarding wait days to weeks for a psychiatric placement.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The lack of standardized assessment for aggression or homicidality could have led to idiosyncrasies in mental status assessment and disposition planning.

    “This could have led to idiosyncrasies in mental status assessment and disposition planning.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The current study conducted interviews with medical providers and did not gather information from the perspective of youth or their families.

    “The current study conducted interviews with medical providers and did not gather information from the perspective of youth or their families.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The journey map did not extend to factors before patients present to the ED or systems outside the ED setting that contribute to the bottleneck.

    “Finally, it should be noted that the journey map did not extend to factors before patients present to the ED (e.g., appropriateness of school referrals, availability of mental health treatment) or systems outside the ED setting that contribute to the bottleneck (e.g., extended lengths of stay on inpatient units, lack of social service agency support).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Similar facilities may find variations in the boarding process and results may not apply to general or community hospitals where most youth receive care for acute mental health services.

    “Similar facilities may find variations in the boarding process and results may not apply to general or community hospitals where most youth receive care for acute mental health services (Santillanes et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Santillanes et al., 2020 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Other studies have demonstrated the effectiveness of training nurses and other medical staff in similar brief interventions.

    “Other studies have demonstrated the effectiveness of training nurses and other medical staff in similar brief interventions (Wolff et al., 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wolff et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    During periods of high patient volume, Pedi PES and CL teams had less ability to work on alternate levels of care, impacting ability to divert patients later in boarding and leading some patients to be admitted to inpatient level of care.

    “In other words, during periods of high patient volume, Pedi PES and CL teams had less ability to work on alternate levels of care, impacting the ability to divert patients later in the boarding process and leading some patients to be admitted to inpatient level of care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The current study was conducted at a single academic medical facility that is a standalone children's hospital.

    “In addition, the current study was conducted at a single academic medical facility that is a standalone children’s hospital.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The current approach to disposition planning can lead to confusion, frustration, disparities in access to care, and anomalous decision-making procedures influenced by any given provider's knowledge of services, bias, or time constraints.

    “The current approach to disposition planning can lead to confusion, frustration, disparities in access to care, and anomalous decision-making procedures influenced by any given provider’s knowledge of services (or lack thereof), bias, or time constraints.”
    Quote in the paperSubstantial claim
61 of 61

  • The paper relies on this without support.

    In typical inpatient psychiatric care, patients participate in a therapeutic milieu intended to provide positive behavioral activation and socialization.

    “In typical inpatient psychiatric care, patients participate in a therapeutic milieu intended to provide positive behavioral activation and socialization.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Research using patient journey mapping with large samples of hospital staff reported limitations from not gathering information from the perspectives of those with lived experience.

    “In contrast, research using patient journey mapping with large samples of hospital staff reported limitations from not gathering information from the perspectives of those with lived experience [51].”

    From The hospital-to-home care transition experience of home care clients: an exploratory study using patient journey mapping (2023) · cites this paper as [51]

    The Methods (Design & Setting; page unavailable) describe patient journey mapping based on interviews with 15 healthcare providers. The Limitations (page unavailable) explicitly say the study did not gather youth or family perspectives. The claim's description of a large staff sample is not supported by the reported sample of 15. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • ED boarding times contradict the stated three-to-four-day average

    Minor

    The results say patients spent an average of three to four days in the ED, but Table 2 reports average ED boarding times of 8.40 to 18.96 hours across the three years. The three-to-four-day figures instead resemble the table's average total boarding times.

1 of 1

Cites

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Related

Authors
Wolff, J. C., Maron, M., Chou, T., Hood, E., Sodano, S., Cheek, S., Thompson, E., Donise, K., Katz, E., & Mannix, M.
Affiliations
  • Brown University (US)
  • Bradley Hospital (US)
Corresponding author
Wolff, Jennifer C.
ORCID
Venue
Administration and Policy in Mental Health and Mental Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2023-01-06
Volume
50
Issue
3
Pages
417-426
ISSN
  • 0894-587X (ISSN-L)
  • 1573-3289
DOI
10.1007/s10488-022-01249-4
PMC
PMC9822692
OpenAlex
W4313627715
Semantic Scholar
6ce2d226884c0f4e50ec974fc166cc9a12a4a8a4
Cited by
43
References
33
Citations by year
2026: 7 · 2025: 17 · 2024: 15 · 2023: 4
FWCI
13.18
Type
journal article
Language
en
Open access
Licence
Locations
  • Administration and Policy in Mental Health and Mental Health Services Research (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Mental Health (T32MH019927)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
Keywords
emergency department boarding, child and adolescent mental health, patient journey mapping, staff perspectives, youth mental health crisis, COVID-19 pandemic, care coordination, disposition planning, patient safety, psychiatric hospital beds, length of hospital stay, children's hospitals
MeSH terms
COVID-19, Adolescent, Mental Disorders, Child, Emergency Service, Hospital, Hospitalization, Humans, Length of Stay, Patient Admission, Patient Discharge, Retrospective Studies

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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