More than 1 in 10 psychiatric emergency department visits by young Medicaid patients lead to boarding, with rates of boarding varying widely from state to state, according to a recent analysis.
Boarding, or a delay in the time until an ED patient is given an inpatient bed, has been cited as an increasing issue across the country’s EDs. The longer wait for appropriate care not only imposes a potential physical and emotional toll on patients but can increase the costs of care delivery while increasing stress and personal safety risks for staff.
The “considerable” incidence of boarding outlined in the study is concerning considering that pediatric Medicaid patients already face systemic barriers to timely behavioral health care, researchers wrote of their findings in JAMA Health Forum.
The analysis of more than 255,000 ED visits for a primary mental health diagnosis found boarding among more than 1 in 5 visits in five states—Iowa, Florida, Maine, North Carolina and Montana, where rates ranged from 27.3% to 21.8%. Substantial variation between these and other states could be due to factors including mental health condition prevalence, Medicaid coverage levels and psychiatric bed capacity, the researchers wrote.
The analysis reviewed Medicaid claims data from 2022 among non-dual Medicaid enrollees aged 5 to 17 years in 44 states. Boarding was defined as a visit spanning two to six midnights. Longer stays were excluded to minimize the risk of coding errors, which the researchers admitted could have lead to a “more conservative estimate” of boarding frequency and duration.
Overall, 11.9% of psychiatric visits resulted in boarding, which was more prevalent among those with primary diagnoses related to suicide or depressive disorders. The average duration of a stay was 2.1 days across the full sample, with the average length of a boarding event running 4.5 days.
In contrast to the five states over 20%, there were 20 states in which boarding rates were below 10%, led by Arkansas’ 2.7%.
“The substantial state-level differences we observed suggest that state-level policies—including an assessment of the continuum of care that includes inpatient and residential beds, subacute beds, non-ED crisis support, and accessible outpatient care—could play a key role in reducing boarding and its impact on youths and their families,” the researchers wrote.