Introduction: Adult Emergency Departments (EDs) in Calgary are facing a crisis of boarded patients admitted to psychiatric in-patient units. In psychiatric emergency care, “boarding” describes the holding of patients in the ED after the decision to admit has been made by a staff psychiatrist and a bed request has been submitted. Literature review suggests psychiatric patients face exorbitantly higher boarding times than any other service in the hospital however little is published on the nature of these adverse events. Examples of adverse patient events from a psychiatric perspective could include: the need to initiate mechanical and/or chemical restraints after admission and while still in the ED, attempts to self-harm, and verbal and physical assault on ED staff. Methods: This study quantifies the incidence of adverse events experienced by psychiatric patients while boarded in the ED. It uses a retrospective chart review of all adult psychiatric patients, age 18 - 55yo, who presented to one of four adult EDs and who were admitted to a psychiatric in-patient unit in the Calgary Zone between January 1, 2019 and May 15, 2019. A randomly generated convenience sample identified 200 patients, 50 from each site, for in-depth review. Results: During the study time period, 1862 adult patients were admitted from emergency departments to the psychiatry service across all four sites. Of the 200 charts reviewed, patients ranged in age from 26-41 (average 34). 52.5% were male with the majority being admitted to a non-high observation bed. The average boarding time was 23.5 hours with an average total ED length of stay of 31 hours for all comers. Those who experienced an adverse event while boarded in the ED experienced a significantly prolonged average boarding time (35 hours) compared to those who did not experience an adverse event (6.5 hours) (p = 0.005). Significant adverse events were associated with the specific hospital site and the type of admission bed needed (high observation versus normal versus short stay) (p < 0.05). Conclusion: Psychiatric patients boarded in Calgary EDs experience a number of significant adverse events. The importance of understanding the reality of the conditions that psychiatric ED patients face while waiting for in-patient placement cannot be overstated. This study is important to emergency medicine as it will allow for deeper understanding of the patient experience while in the ED and identifies areas that may require further advocacy amongst ED staff and our psychiatry colleagues.
A Multidisciplinary Social Casework Center with a Staff Psychiatrist