Wait Times and “Boarding” of Psychiatric Patients in Emergency Rooms

Monday, July 7th, 2008
This post was written by Melanie Matthews

The world was horrified last week after watching a surveillance video of the death of a female psychiatric patient in a New York hospital’s ER waiting room. I am not going to embed the video here. If you go to YouTube.com and search on “Kings County Hospital,” you can choose from at least 48 variations of the video.

What’s important to note is that treatment depicted in this hour-long viral video raises a host of disturbing concerns about quality of care, safety, security and confidentiality at Brooklyn’s Kings County Hospital, which last week pledged to check on waiting patients every 15 minutes and attempt to shorten the hospital’s median waiting time to around 10 hours, among other promised reforms.

The latter goal is more than twice the average waiting time of four hours and five minutes reported in Press Ganey’s 2008 ED Pulse Report. In a survey of 1,524,726 patients treated at 1,656 EDs nationwide between January 1 and December 31, 2007, New York EDs ranked 43rd in average wait times, with an average wait time of 282 minutes. (First was South Dakota at 165 minutes; last was Utah at 385 minutes.)

Long waits in the ED are not uncommon for people with psychiatric illnesses due to the practice of “boarding” — holding admitted patients in the ED instead of moving them to an inpatient bed. According to a survey of ED directors by the American College of Emergency Physicians, psychiatric patients (including children) admitted to the hospital from the ED can wait 24 hours or longer for an inpatient bed, principally because of a lack of psychiatric beds. Almost 80 percent of the 328 ED directors who responded to the survey said their hospital boards psychiatric patients in the ED. Thirty percent said their hospitals board psychiatric patients between eight and 24 hours, and more than one-quarter said that their hospitals board children with psychiatric illnesses for that long.

Eighty-five percent of these doctors said that wait times for all emergency patients would improve if there were better psychiatric services available. More than 80 percent agreed that regional dedicated emergency psychiatric facilities nationwide would work better than the current system for dealing with psychiatric emergency patients.

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