Behavioral health patients spend a significantly longer time waiting in emergency departments (EDs) when compared to general-medical emergency patients. These long lengths of stay in the ED is a phenomenon known as psychiatric boarding. Psychiatric boarding occurs when a behavioral health patient spends an excessive period in the ED after the decision to discharge or admit the patient has been made.

The increasing prevalence of psychiatric boarding in recent years is largely attributed to the lack of parity in emergency care between behavioral health and general medical patients, shortages of psychiatric beds, and barriers preventing behavioral health patients from accessing affordable and timely mental healthcare.

Psychiatric boarding significantly impacts the outcomes and quality of care for behavioral health patients and other ED patients, the financial health of the hospital, and the satisfaction and wellbeing of emergency department personnel.

Historically, discussions on psychiatric boarding have focused on policy changes and interventions at the community level. However, these interventions can be difficult to coordinate and implement. As a result, this project evaluated health-system-level interventions to address psychiatric boarding. Interventions were categorized based on the point of intervention and the financial, time, and space requirements of the intervention.

After evaluation of the evidence supporting various interventions, I propose a three-tiered intervention plan that recommends hospitals and health systems prevent and mitigate the impact of psychiatric boarding by:

1) providing specialized psychiatric training to ED personnel;

2) making alterations to the physical layout and staffing of EDs; and

3) developing alternative psychiatric-emergency facilities.

Sophia would like to thank her faculty sponsor Dr. Kevin Syberg for their support of this project.