The Impact of Psychiatric Patient Boarding in Emergency Departments
Open accessAbstract
Objectives. Studies have demonstrated the adverse effects of emergency department (ED) boarding. This study examines the impact of resource utilization, throughput, and financial impact for psychiatric patients awaiting inpatient placement. Methods. The authors retrospectively studied all psychiatric and non-psychiatric adult admissions in an Academic Medical Center ED (>68,000 adult visits) from January 2007-2008. The main outcomes were ED length of stay (LOS) and associated reimbursement. Results. 1,438 patients were consulted to psychiatry with 505 (35.1%) requiring inpatient psychiatric care management. The mean psychiatric patient age was 42.5 years (SD 13.1 years), with 2.7 times more women than men. ED LOS was significantly longer for psychiatric admissions (1089 min, CI (1039-1140) versus 340 min, CI (304-375); P < 0.001) when compared to non-psychiatric admissions. The financial impact of psychiatric boarding accounted for a direct loss of ($1,198) compared to non-psychiatric admissions. Factoring the loss of bed turnover for waiting patients and opportunity cost due to loss of those patients, psychiatric patient boarding cost the department $2,264 per patient. Conclusions. Psychiatric patients awaiting inpatient placement remain in the ED 3.2 times longer than non-psychiatric patients, preventing 2.2 bed turnovers (additional patients) per psychiatric patient, and decreasing financial revenue.
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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).”
From Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping (2023) · cites this paper as Nicks & Manthey, 2012
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- Authors
- Nicks, B. A., & Manthey, D. M.
- Affiliations
- Wake Forest University Health Sciences (US)
- Corresponding author
- Nicks, B. A.
- ORCID
- Nicks, B. A.
- Venue
- Emergency Medicine International
- Publisher
- Hindawi Limited
- Published
- 2012
- Volume
- 2012
- Pages
- 1-5
- ISSN
- 2090-2840 (ISSN-L)
- 2090-2859
- PMC
- PMC3408670
- OpenAlex
- W2060268568
- Cited by
- 189
- References
- 23
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 15 · 2023: 13 · 2022: 18 · 2021: 15 · 2020: 22 · 2019: 23 · 2018: 17 · 2017: 15 · 2016: 7 · 2015: 11 · 2014: 8 · 2013: 2
- FWCI
- 7.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Emergency Medicine International (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, emergency department length of stay, psychiatric hospital admissions, hospital bed turnover, emergency department throughput, hospital financial impact, reimbursement, resource utilization (health care)
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