Emergency Department Boarding of Behavioral Health Patients (CRS Report for Congress)
| Release Date |
Revised July 19, 2018 |
| Report Number |
IF10929 |
| Report Type |
In Focus |
| Authors |
Elayne J. Heisler; Kelsey Cramer |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Summary:
This In Focus outlines emergency department (ED)
boarding of behavioral health (BH) patients. Behavioral
health refers to patients with psychiatric and/or substance
use disorders. Boarding refers to the holding of inpatients in
an ED after an admission or transfer decision has been
made. ED boarding, as it contributes to ED crowding, has
been a long-standing area of concern for Congress, payors,
and health care providers (see CRS Report R43812,
Hospital-Based Emergency Departments: Background and
Policy Considerations). This In Focus highlights areas for
research and discusses policy options Congress may
consider to reduce BH patient boarding.
In general, patient boarding can last from hours to multiple
days. Data show that BH patient boarding times are longer
than non-BH patient boarding times. For example, research
examining one U.S. hospital and published in the journal
Emergency Medicine International found that the average
length of ED stay was more than three times longer for BH
patients compared with other patient types (Nicks and
Manthey 2012). BH boarding typically occurs because there
are too few BH providers available to diagnose and treat a
patient or because, after an assessment has been made, an
inpatient psychiatric/substance abuse disorder treatment bed
is not available. As a result, BH patients are boarded in the
ED, which contributes to a backlog in the treatment of other
ED patients. In the same Emergency Medicine International
study, the researchers found that each boarded BH patient
prevented an additional two patients from being seen.
