Psychiatric Boarders in the Emergency Department
The number of psychiatric patients who present to emergency departments (EDs) has increased in the last few years; many of these patients will need to be admitted to an inpatient bed. The care of psychiatric patients in the ED is commonly delayed by limited involvement of psychiatric specialty personnel and lack of psychiatric resources in the community. These problems have led to the boarding of psychiatric patients in the ED. In many EDs, it has become common practice to board psychiatric patients, until a staffed, inpatient bed becomes available or transfer to an appropriate facility occurs. Due to the lack of psychiatric resources in many communities, this period can last hours to days. Emergency department boarding is a poor option for the psychiatric patient as it compromises their comfort, privacy and medical and psychiatric care. The psychiatric patient may become agitated or escalate abnormal behavior while waiting for an inpatient bed or transfer. Boarding also delays the care of others, provokes ambulance diversion, and increases the number of patients leaving the emergency department before being seen by a physician. Boarding creates a significantly more stressful practice environment and contributes to professional dissatisfaction, burnout and high staff turnover. AAEM recommends that the psychiatric services at each hospital be actively and regularly involved in the management of psychiatric patients who board in the ED. AAEM calls upon hospitals, health care institutions and community mental health resources to seek alternative options other than ED boarding to hold psychiatric patients awaiting hospitalization or transfer to an appropriate facility. AAEM also calls upon regulating agencies to issue rules that forbid boarding of psychiatric patients in the ED.
This position statement is supported by the American Association for Emergency Psychiatry