(PS5-C67) Applying Implementation Strategies to Understanding the Adolescent Psychiatric Boarding Crisis

Within the past two decades, the mental health crisis among children and adolescents has grown significantly, leading to an increase in psychiatric presentations to the emergency department (ED). National trends in mental health showed that between 2009-2015, mental health-related ED visits increased 56.4% for pediatric patients. Extended periods of uncertainty and psychological stressors related to the COVID-19 pandemic have only led to a rise in these numbers. For ages 12-17, there was a 31% increase in mental-health related ED visits in 2020 compared to 2019. Further contributing to this increase, the scarcity and fragmentation of community mental health resources and the COVID-related mental health facility closures have limited options for those seeking support. Given these shortages in available psychiatric care, emergency departments have assumed the role of de facto psychiatric crisis units, thus eliciting inconsistent care and increased wait times. The phenomenon of waiting for appropriate psychiatric care in the ED, known as boarding, has become a national crisis as adolescent trends in mental health continue to rise. To examine adolescent psychiatric presentations to our emergency department, we used a technique drawn from implementation science known as patient journey mapping to chart the flow of patients through a local healthcare system. Through interviews with emergency department, medical, and psychiatry staff, we evaluated the providers' perspective of the level of care received during the boarding process and barriers to steadily moving patients through the system towards necessary levels of psychiatric care. Within the past fiscal year, over 4000 patients presented to the emergency department for psychiatric concerns, accounting for 8% of the total pediatric presentations. Of these index psychiatric presentations, 49% of patients were admitted for further disposition. Results will present the patient journey map, which is a visual approach to capturing the experience of patients who follow unique and unexpected trajectories through the healthcare system. The journey map will discuss the primary themes affecting patient flow, such as varying diagnostic acuity, staffing shortages, and the impact of COVID-19, that contribute to the boarding crisis. Future areas of improvement and intervention in the psychiatric boarding process, including psychological training, assessment, and staffing, will be discussed in the context of the findings.