If that option is missing, the emergency rooms have taken over the slack. A recent survey of 88 children’s hospitals across the country found that 87 regularly admit children and adolescents to the ED at night. On average, each hospital saw four interns per day, with an average stay of 48 hours.
“There is a pediatric pandemic of mental health boarding,” said Dr. JoAnna K. Leyenaar, a pediatrician at Dartmouth-Hitchcock Medical Center and the lead author of the study. In an interview, she extrapolated from her research and other data to estimate that at least 1,000 young people, and perhaps as many as 5,000, board the country’s 4,000 emergency rooms every night.
“We have a national crisis,” said Dr. Leyenaar.
This trend goes way against recommended best practices set forth by the Joint Commission, a nonprofit organization that helps shape national health care policy. According to the standard, adolescents coming to the ED for mental health reasons should not stay there for more than four hours, as an extended stay could compromise patient safety, delay treatment and divert resources for other emergencies.
But in 2021, the average adolescent in the emergency room at Boston Children’s Hospital spent nine days waiting for a hospital bed, up from three and a half days in 2019; at Children’s Hospital Colorado in Aurora in 2021, the average waiting time was eight days, and at Connecticut Children’s Medical Center in Hartford, six days.
Emergency care boarding has also risen in small, rural hospitals, with “no pediatric or mental health” specialists,” said Dr. Christian Pulcini, a pediatrician in Vermont who has studied the trend in the state. “There is one clear conclusion,” he recently told the Vermont legislature. “The emergency room is not the right setting for children to receive comprehensive, acute mental health care.”