Effect of a Regional Dedicated Psychiatric Emergency Service on Boarding and Hospitalization of Psychiatric Patients in Area Emergency Departments
Open accessAbstract
INTRODUCTION: Mental health patients boarding for long hours, even days, in United States emergency departments (EDs) awaiting transfer for psychiatric services has become a considerable and widespread problem. Past studies have shown average boarding times ranging from 6.8 hours to 34 hours. Most proposed solutions to this issue have focused solely on increasing available inpatient psychiatric hospital beds, rather than considering alternative emergency care designs that could provide prompt access to treatment and might reduce the need for many hospitalizations. One suggested option has been the "regional dedicated emergency psychiatric facility," which serves to evaluate and treat all mental health patients for a given area, and can accept direct transfers from other EDs. This study sought to assess the effects of a regional dedicated emergency psychiatric facility design known at the "Alameda Model" on boarding times and hospitalization rates for psychiatric patients in area EDs. METHODS: Over a 30-day period beginning in January 2013, 5 community hospitals in Alameda County, California, tracked all ED patients on involuntary mental health holds to determine boarding time, defined as the difference between when they were deemed stable for psychiatric disposition and the time they were discharged from the ED for transfer to the regional psychiatric emergency service. Patients were also followed to determine the percentage admitted to inpatient psychiatric units after evaluation and treatment in the psychiatric emergency service. RESULTS: In a total sample of 144 patients, the average boarding time was approximately 1 hour and 48 minutes. Only 24.8% were admitted for inpatient psychiatric hospitalization from the psychiatric emergency service. CONCLUSION: The results of this study indicate that the Alameda Model of transferring patients from general hospital EDs to a regional psychiatric emergency service reduced the length of boarding times for patients awaiting psychiatric care by over 80% versus comparable state ED averages. Additionally, the psychiatric emergency service can provide assessment and treatment that may stabilize over 75% of the crisis mental health population at this level of care, thus dramatically alleviating the demand for inpatient psychiatric beds. The improved, timely access to care, along with the savings from reduced boarding times and hospitalization costs, may well justify the costs of a regional psychiatric emergency service in appropriate systems.
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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).”
From Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping (2023) · cites this paper as Zeller et al., 2014
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- Authors
- Zeller, S., Calma, N., & Stone, A.
- Affiliations
- Alameda Health System (US)
- Wright Institute (US)
- California Hospital Association (US)
- Corresponding author
- Zeller, Scott
- ORCID
- Zeller, Scott
- Venue
- Western Journal of Emergency Medicine
- Publisher
- California Digital Library (CDL)
- Published
- 2014
- Volume
- 15
- Issue
- 1
- Pages
- 1-6
- ISSN
- 1936-900X (ISSN-L)
- 1936-9018
- PMC
- PMC3935777
- OpenAlex
- W2050861914
- Cited by
- 136
- References
- 27
- Citations by year
- 2026: 15 · 2025: 9 · 2024: 9 · 2023: 14 · 2022: 11 · 2021: 17 · 2020: 13 · 2019: 10 · 2018: 14 · 2017: 12 · 2016: 1 · 2015: 5 · 2014: 4 · 2013: 1 · 2012: 1
- FWCI
- 7.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Western Journal of Emergency Medicine (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship (California Digital Library) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- psychiatric emergency care, emergency department boarding, boarding time, psychiatric hospitalization, regional mental health services, emergency department transfers
- MeSH terms
- Mental Disorders, California, Emergency Service, Hospital, Hospitalization, Humans, Length of Stay, Mental Health Services, Regional Medical Programs, Models, Organizational
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